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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME v <br /> v" ' � � r CnY` �oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> \/\1 I 1 441_ Qar-Qy+r- O . C.O\ j r bi1.S� \IJi , 12S Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> °12L) 'LI C1` 'LC-AS r...j%-}•c,.1. - .ht. 'rr 'I x Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (yIritszn610445 i5c4ls l• Site Plan including location I,'(�`. <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 30--+6 Cv stletmCt-055i n , <br /> i <br /> (City,State,Zip) (City,State,Zip) n Setbacks b`�,- <br /> PHONE ON �rh, ' %�� Q Site Plan approval from <br /> bo$ . 3 . 1613 applicable township. /V r <br /> E-MAIL ADDRESS E-MAI L ADDRESS <br /> • • . Sor+iSa.r>SR, 1 Lair, ® Floor plans to scale ✓" <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ' Elevation of property <br /> PARCEL �1 I ?��3 <br /> frontage drawn to scale. <br /> NUMBER ©�V�G� 'D�]ZC712O{� ��� , �� SF <br /> TOWNSHIP: SECTION: IV r\'` ' <br /> in Oin�"rLL`3 i- ,'tom-8 1/a: NE ` N,t :N vatI)�II� Driveway permits v <br /> ADDRESS: • <br /> n11:..) (state,county,town) <br /> � 57 IP 11 tC <br /> CSM: LOT SUBDIVISION BLOCK/LOT `Sanitary permits <br /> �3y,5 3 I (public,private) y 11 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> AIEw `►AOS Q--. \\ 1\ NJ A 0, I) O\1 C `,t 11 L iZoning District <br /> ° <br /> . EIThis project is a new building or structure. C QL_K <br /> Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> EWER ZEPTIC I 2' 11 —Cot rydress <br /> sting) U <br /> HEIGHT IN FEET: ZEPTIC <br /> NUMBER OF STORIES: (Not including basement) r1 O a <br /> 2 C S -or ❑ Wetland/Floodplain/ L 7v- <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions inc ing unfinished area,attach ges and above grade decks or porches) hQ <br /> BASEMENT: ei+ <br /> � 1ST FLOOR: 7 ❑ ErosionControl permit C I �V C <br /> 2 O B 3 �'^, Z s-� + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, ,�pr <br /> i lJJ _ filling/access) , <br /> 2ND FLOOR:/ 3RDLOOR: c i i 00 L pq / >D, <br /> , v4� <br /> e, ivi A . I ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: t(21—.421and available options. <br /> ♦ ♦ ♦ ♦ ♦ ♦ <br /> (Please round to nearest dollar) $ 3 O L <br /> 1. The property is within 300 feet of a stream ori 1000 feet from a pond or lake? ' ,Yes IVo ,on't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ' o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? '12Yes _ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes a° <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) fres Elio ;Won't know <br /> 7. Is this to correct a violation? QYeso <br /> C j „ <br /> i �, APPLICATION MUST BE SIGNED <br /> Com-- C('t, 1 - (Continue on Back) — -* --i.REV(01/19) ' % <br /> a <br />