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ZONING PERMIT APPLICATION trirwtrw.countyofdane.com s>upPLElttttokWllejb=Elpijr <br /> I <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME ' / 1 -3 _, I __ f <br /> f/�( <br /> OWNER (Number.Street,City,State, _ M Zoning Status;CUP; <br /> L'Vpeed Restriction;CSM <br /> 7-3,__/5PlmE RD. 1-ARK; vr r l g Ic Variance(it ) <br /> HOME PHONE 'CELL PHONE E-MAIL� DORES �. <br /> 4350 1y5"9-g!,,, CV ",.• )(.....• 1410.1' eit,"'t [15ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION / nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Q4__ P9� Site Plan including location <br /> AGE,ADDRESS 'CONTRACTOR ADDRESS ;of well/septic <br /> pd67, 1 <br /> City.State,bp) (City,State.Zip) CI Sktbacks <br /> �a ror�en W 1 / <br /> PHONE PHONE O Site Plan approval from <br /> J6O )34=G713 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS r / <br /> R lir,,1/ �, a [g Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co,dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL �7 t� Ci /� J, frontage drawn tpseele. <br /> 0rfi eLa �oeos'09394 b fZM-16 1 2l.• <br /> TOWNSHIP'' SECTION: �,. � <br /> V 13- b Nk 4-1 Y:-- .V\ 1/4:-3. Y V ElDrivewaype its <br /> ADDRESS: ---- (State;county,town,),- <br /> -61 58 S UD pates /V / 1 <br /> �- O Sanitarppefmits <br /> Cm j '7. ' LOT 'SUBDIVISION BLOCK/LOT <br /> (ptylic;private) 1; <br /> PROPOSED"PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION' <br /> 44ty), guildoliJ Zoning District <br /> ❑This oject is a new building or structure. in Permitted Use? <br /> 11B11-iis project is an addition/alteration to an existing building or s ct <br /> SANITARY SERVICE: [PERMIT NUMBER: 0 Rural dress <br /> EWER ,1�+\-y,E1 EPTIC (�V/ f' (new/ xistin0' <br /> HEIGHT iN FEET: ` NUMBER OF STO IES: (Not including basement) l <br /> I 1 — 0 Wetland/Flo ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shores attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) EroslonCOntr permit <br /> BASEMENT- 1ST FLOOR I h <br /> ,,'„a <br /> (� vTOTAL SQUARE FOOTAGE: 4. (slopes,d' urbance, <br /> LI filling/apdess) <br /> 2ND FLOOR: 3RD FLOOR: 14 J /� <br /> — -- --i ----_--_-------__._—__-- ❑ Review Location Survey 1/�\ U <br /> ESTIMATED CONSTRUCTION COST: i r r and available options. <br /> (Please round to nearest dollar) -> -. t <br /> moi.. , <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyesto Don't know <br /> 2. Is there a wetland or floodplain on cr near the property? DY�s o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? les [ENO 4. Has there been a zoning permit issued for this property in the past 5 years? DYes LEWD <br /> 5. is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) Oyes f <br /> Lt o ODon't know <br /> 7. Is this to correct a violation? Dyes L0 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -a -o <br /> REV(C111S1 <br /> C <br />