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I <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> KG4 4\) 16 00 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3Co I piteit}c,.41- 1b Cr Veroku1/4.l Wi 535'93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60 - 113 -3O? k ,Q 5%,. ,,,,,,,v ct- Covet ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG�f NT N E C TRACTOR NAME <br /> K,� 64,v,j) voJ�VlWM NAME.. LL-C, ❑Site Plan including location <br /> AGENT ADD ES \ CONTRACTOR DRES r of well/septic <br /> 5142.1 tevvv t` 1 rk,_I si2zz, Pvki g‘vee-Tva,I <br /> (City,State,Zip) ` �, s359P (cyo yit /�)C 5 ❑Setbacks <br /> PHIO)P EV PHONE �, 3S�g ❑Site Plan approval from <br /> C04 -39,9-3012— Ppv - y- 3011 '7--, applicable township. <br /> E-MAIL ADDRESS I E-MAIL ADDRESS )) <br /> bt;CK6., rvl ,,A ,evwi byxtio k „,.1,60,C o wt ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: <br /> El P RC ER 0 38 0 70 D -19 3 ' v?3 (? A-a 1. t gs frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Mt`d dJ - An '/a: i/t/4. ❑Driveway permits <br /> (state,county,town) <br /> ADDRE?R(01 I * Po`,4$ C fi, Ucist ,�l 53 593 ❑Sanitary permits <br /> CSM: LOT 3 SU DIVISION BLOCK/LOT <br /> Pht*StAil 1°114 <br /> n/� (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIOV��� �� / <br /> 1 e_ci ❑ Zoning District <br /> J[�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: PERMIT NUMBER: ❑ Rural Address <br /> DEWER DEPTIC (new/existing) <br /> HEIGHT IN FEET: I I NUMBER OF STORIES: (Not including basement) <br /> I 1 1 -1 ' _/... ❑ 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 /> ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: `` ,$ TOTAL SQUARE FOOTAGE; , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> I4 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $Q v/[� and available options. <br /> (Please round to nearest dollar) �P Sod.0D <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ekes 0No ®bon't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes Do Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Ekes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes 'lo <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) :Yes Do ❑Don't know <br /> 7. Is this to correct a violation? Oyes Do <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --0 —► —1 <br />