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WZF2011-krc-kit 523__. ) D <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> t Y ∎ }_e_. '. 73.0k--, CA-,Q itAts <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> -2 cxx, Prv�; ;e_ j,,, 2--Z.0 r -1 rv4i r'',� CQ.� Sac, tar 53SW, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (ice--id <br /> 4'-- i I 1 (;;O*9L.3—((o2Z. A e-r lice f(r�;,J)1-md S.ecir►'v ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME , } <br /> lJ II "r-) 3t-- I-t�C"�-(01-, (4bmES LNC. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2 c 'c' J i xt-i r t c S-.. 7 Lt:,0 F'Mki r i S <br /> (City,State,Zip) City,State,Zip) ❑Setbacks A I <br /> h- r-,. dc, r,c_t (, 635--}v a_etirit_ 40 v ` I 01 S353v <br /> PHONE PHONE _ ❑Site P n t royal from <br /> (QD`2)-- (�`�`f — .�1 I I ---(..`i'.� e`S-2-C —__ — app(' a •I ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> - , ,_ (=rr�`�orneS r'c.m akt+J��_ hekcrLIAAL7Yn S. CLAN- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi,us/) <br /> 0 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ®PARCEL frontage drawn to scale. <br /> NUMBER b J T j U4.-C�-I -GGI 1 -9I -lo ✓ A -- I <br /> TOWNS P: SECTION: <br /> — <br /> ,,- �` Y. /,/, t� ❑ Drivewa Yp <br /> permits R Est)�� -L-Z= 7 <br /> ADDRESS: r (state, county, town r <br /> 'j <br /> CSM: LOT �� („,'-' <br /> /�'$ DIV�ISJN1 BLOCK/LOT ❑ Sanitary permits <br /> 3 65 2-ci •2-- 2 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ��t‘'G-L-- -�v . (2.-�`->ic9 .1c---- w,'3-4. c:r ,�.. C-7rt-n-,�if2-- ❑ Zoning District <br /> . TThis 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 sdr�PS`� <br /> EWER EPTIC (new/existing) 1- f N dy <br /> HEIGHT /: 1 NUMBERROlFF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> �w0 Shoreland (attachment) <br /> A TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> — — — ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> c Z3 q C•` ' +, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> _ It '1 <br /> 3RD FLOOR: filling/access) <br /> 2ND FLOOR: <br /> l 13 L'C' �'"3 0 , ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ -4► ♦ -4► $ 3 Li rjt�c> and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo .Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ales ,JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ONo _p„A;5.,(tie <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) DYes XENo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ENo <br /> X13; '2 4 0 = 39 <br /> g 7 APPLICATION MUST BE SIGNED <br /> 545-112(4108) (( (Continue on Back) -4. -+ -b <br />