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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> p.QWNER NAME <br /> kW/14A1I S. a-A-ck- l tv-e V e . 1'<es Se_Y11 G k oning Stat - <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restri •••..ti, • 1 <br /> ��°1 low tD\/o(oL k Rek•t De_e_-Ct>°ka. W t 3S3( Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 1pU5 5Ia.qs,03 ( OB5Ia. gS03 KL7'eA co t al ctvict b0J L&)o7ks,G-vv` itePlan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME . <br /> ❑Site ' eluding location <br /> AGENT ADDR• S CONTRACTOR AD SS • of ptic <br /> J (Cit(City,State,Zip) <br /> y,State,Zip)PHONE PHONE a Plan approval from <br /> applicabl township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.diane.wi.us/) <br /> El tion of property <br /> PARENT PARCEL NUMBER:ol . ,,O CURRENT ZONING:03g G, ACREAGE: rontage drawn to scale. <br /> in PARCEL 07 I\ I3 9-eoe keel L c; — i . 1 <br /> NUMBER d' "rP4T—� <br /> TOWNSHIP: SECTION:e e r t e l c ❑DfIV2W rmlts,✓t�] <br /> Q, 14 141%: (stat o nty,town) <br /> ADDRESS: <br /> 39loci -D Vo`ra-k gel. , l�ee.�'-Cie\c�, tzJ1 533 ( ❑Sanita •- • n C <br /> Cg ` �� LOT <br /> I SUBDIVISION BLOCK/LOT •_ • C, • •vate) �J∎..z),� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Re--10[lice- / &AA 161 N /�� 6L-,r r L�S)(s otiaT oning District <br /> . <br /> This project is a new building or structure. UP rrnitted Use?Co, <br /> This project is an addition/alteration to an existing build' g or structure. <br /> SANITARY SERVICE: PERMIT N M� /' <br /> E : ral Address <br /> EWER R E P T I C y 11 g S(�4.1 (new/qn? <br /> HEIGHT IN FEET. NUMBER OF ORI (Not including basement) ,-, ��,� amend/Floodplain/ �1/ / <br /> ��� Shoreland (attachment) ajelL,-47 AREA TO NEAREST SQUARE FOOT: ) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionControl permit ` � <br /> BAS MENT: 1 ST FL0 R es, •• turban s <br /> /O 3�1� TOTAL SQUARE FOOTAGE: j (slo P <br /> filling/acces c, � / <br /> 2ND FLOOR: ))�� 3RD FLOOR: �����, ��� ` ' <br /> i I 5 C if G �� �s / li"Review Location Survey A' <br /> ESTIMATED CONSTR TION COST: ♦ ♦ ♦ ♦ ♦ ♦ ) and available options.(Please round to nearest dollar) $ )06k 171 i <br /> i v() <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑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? ❑Yes No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# al-1-(v ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ENO ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -4 <br /> 545-112(4/08) <br />