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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> KYLE ItA)) 6 Oat rn/ // '✓ 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 30 Zg' ff1pfj 1//t0 ILL v'W,1i4 5-3573 Variance(# ) <br /> HOME PHONE CELL PHONE 1E-MAIL ADDRE S <br /> 6 P$r , 2--- VA 1+14/' OfKle "141'1' co'''. 0 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME _ 41.-4R/K <br /> A4IDtiy97-.SkLf/L /Ok/ 'Refc4ICslii5 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Yc5_ .. .(>r) ,,e! )/Z1t'A <br /> (city,State,Zip) (City, a�)Zip) ,)/ (-di- 5-3 7b.r-- Setbacks <br /> PHONE PHONE Y ❑Site Plan approval from <br /> 6OS 35, 2. Q63 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r,k w,,,,)se/0- eu/&. '©"- n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: p Elevation of property <br /> 0PA CER 0EL '023- iP� -� 1 I' 3 a frontage drawn to scale. <br /> TOWNSHIP: - SECTION: <br /> 76"I N S F 5 o'1-1 k61)4- 1/.: '/4'/4: (state,county,town) <br /> ADDRESS: <br /> ..0 Z g /IUD 4! ✓/Ew 7M/L VLo" + 5-15-- El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 13 Lt 1/ I-i Dp6e Pi PC <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> IC Kr.J 6 040 /t'f / 5 ("LAX S y 37B-4 ❑ Zoning District <br /> . iis 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: PERMIT NUMBER: ❑ Rural Address <br /> EWER EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /15' / /6 r ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> Le/CI <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 32_ pro <br /> fS� 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? Wes DVo Eron't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres EJVo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? []4es Olo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? f Yes alo <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) QYes Elo QDon't know <br /> 7. Is this to correct a violation? QYes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i —► <br /> 545-112(4/08) <br />