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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-APP <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> CANER YAIAE " [� �1 <br /> C_ 1 }ber "�S I S -_ ❑Zoning Status:CUP: <br /> :r,3 Baa IS_1(3U V\ Q�w Deed <br /> ia ce0trt ion:CSM <br /> 3 variance tce(Y ) <br /> NOME PHONE CELL PHON (-MAL ADDRESS • <br /> a ss_ vas .1/4 r , 31 J c' v^Al Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> ANENT MANE aNNTRACTORNNAM I ' <br /> 1 7��N 6 `�—AvNEN S U., ( ❑Sae Plan including location <br /> ANENT ADDRESS IodHTRACTORADOR ssof well/septic <br /> L-4SS SVMfe ,G V-atw $ SrIsa� <br /> ICL",Slaw ZuaR.w <br /> l (CAY . l f SethaCICS <br /> PHONE --- PRONE n p ❑Site Plan approval from <br /> tWOO 33;l11U applicable township. <br /> EAAAIL ADDRESS EMAIL DOR -- ` <br /> ti. IL. .NpY i k Veus l ably\ 0 Floor plans to scale <br /> PROPERTY;LOCATION INFORMATION (tt..:p:;acccssdane.co.Gane.wi.us.) <br /> PARENT PARCEL N :T' O Nr ZONW(: ACREAGE ❑ElevaNOR of property <br /> ❑PARCEL ` y \ ` 1.I \ O % from drawn to scale. <br /> NUMBER E)G�� 1Q IS!• fD . t�h'W �� ' 1P+ <br /> 'TOWNSHIP: `_€Q`a, 31447/SECTION: 14: '4: ❑Driveway permits <br /> AODRETT '3 <br /> U A�L ttt��� (state.county.town) <br /> 3to)) SCsddtb Rtes"VsDA APPROVAL BY MARIAN <br /> CSM !LOT 'SUBONISON aOaaoT ❑Subic. roampeme0K•S'FRO MDeeK <br /> \� (pubic.pnvat� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRPTKN1 ,J J <br /> S {pyy`(7V l) CAIKALNJChV11AY\ IJ ❑ Zoning District <br /> `9This project is a new building or structure. ❑ Permitted uses YES <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARYSERYICE PERMIT NV.IER. U Rural Address EX <br /> EWER )EPnc (new/existing) <br /> HEIGNTB FEET / �a MASER OF TORIES. (NgklWOng UgxmNn) >300' STF EAM <br /> l0 7' I ❑ Wetland/Floodplain/ <br /> - - Shoreland (altachnnRBVIBNED <br /> AREA TO NEAREST SQUARE FOOT: BY HANS <br /> (Outside d MERSIGns exuding uMMIshed area.attached garages and above grade decks a Poreriesl <br /> BASEMENT: 1STFt00a ❑ ErosionControl permit <br /> 388 4 TOTAL SQUARE FOOTAGE: 4 (slopes.disturoance. NO <br /> — filEngfacceSS) <br /> wio FLOOR: VIDRDOF <br /> `1 I `11.0 00 300 <br /> ❑ Review Location survey No <br /> ESTIMATED CONSTRUCTION COST: W and available options. <br /> (Please mune to nearest(oital) $ r•—) ooc <br /> EAMW1. The properwithin 300 feet of a stream or 1000 feet from a pond or lake? YES, SIproperly s ►( <br /> o Meant know <br /> 2. Is there a wetland or floodplain on or near the property? NO.... Lives Oyes o NI.•n't know <br /> 3. Have you talked with the township about your project and are they in agreement?.... oyes3 <br /> 4. Has there been a zoning permit issued for this properly in the past 5 years?............. :fres DNo <br /> 5. Is this project associated with a rezone/CUPNadance(petition/appealS ) (leave blank if none) <br /> 6 Is a location survey required? (see reverse) Dees nto Thon'i know <br /> 7. Is this to correct a violation? Dees . J° <br /> $88.80 APPLICATION MUST BE SIGNED <br /> OE:.p/:e9, (CUntInue On Back) —. —A —• <br />