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7DANE COUNTY <br /> -;1"1.-' ,'.,, <br /> `y ` ` ZONING PERMIT APPLICATION WWW.DANECOUNTYPLANNING.COM <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> SID U 6 a145(2rtialial CIDL7 (NA R�h,pp .i ❑Zoning Status; CUP;AD ESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> M'l &tNS d %4 W t SS?e-/ Variance(# <br /> ) <br /> HOME PHONE CELL PHONE E-MAIL S5s <br /> (9O '-112- I53Z (tor-112.- 1552— rust, af'_Z Qkoo. crnvt 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME p CONTRACTOR NAME <br /> 'Pat( goffa✓ 'U$ Slue ®Site Plan including location <br /> AGENT ADD MSS CONTRACTOR ADDRESS of well/septic <br /> ZOl ) l'tKcoIA 40 <br /> (City,Stay,liti '1` s;5847 (city,State,Zip) [d Setbacks <br /> PHONE W PH9NE ❑Site Plan approval from <br /> ((Dr-M-7451 1-Z17.,?S„?2A I applicable township. <br /> E-MAIL ADnR S • E-MAIL DDRESS <br /> ?alr v QC'kV/ 1 Ll e5 'l' �rn ❑ 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 DSIl15 207 DS' 34. 7 <br /> frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> t/VK4-1l( • 1/4: .1/4: ❑ Driveway permits <br /> AD �S: <br /> (state,county,town) <br /> t 'DDDREES+' CD(11 x5 124 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 7 /r'vl ; S W D i• Frtr ! .4 4 k) Stoo}'TrvDI"/� <br /> JO ❑ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PM- PERMIT NUMBER: ' ❑ Rural Address <br /> DEWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ID' 2" i ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> 0 M 2 4, TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> b D -i' l4Z ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -0. ♦ --0 and♦ �S and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [\lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? r]Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes K]No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies El. ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Eli o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -► <br /> REV(01/19) <br />