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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT well�App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> r;;_ n '-Mc <br /> David Langendorf <br /> ❑Zoning Status; CUP; <br /> U'r:NE:R ADDRESS tNumoer Sheet City State,Zip) Deed Restriction; CSM <br /> 4906 Lantern Hollow Deforest WI 53532 Variance(# ) <br /> HC,/E PHONE CELL PHONE 'E-MAIL ADDRESS <br /> (608)576-8994 david.langendorf @assurant.com <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> SE NT NAME CONTRACTOR NAME <br /> Jeanette Acker I Malibu Pools ❑Site Plan including location <br /> --N'1 ADDRESS ---__..— CONTRACTOR ADDRESS of well/septic <br /> 102 N holiday Drive 1 7182 Hwy 14 <br /> :.:.;, Stale, p) '(City,state,Zip) ❑Setbacks <br /> Waunakee Wi 53597 1 Middleton WI 53562 <br /> F, `z_ HONE ❑Site Plan approval from <br /> (608) 849-6770 i (608) 575-6188 applicable township. <br /> L--",'e,IL ADDRESS TE-MAIL ADDRESS <br /> jeanette.acker@tOs.net I tcmalibupools @tds.net ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane,whusi) Li Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE. <br /> p2 PARCEL 1 0909-363-9760-0 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION: <br /> Vienna 36 I A: sw +/+/A: se El Driveway permits <br /> _..............__._.._......._...__..____.____._.__..._..._____.._ _._._� __ _____.__.___ (state:county,town) <br /> aD,�RESs <br /> 4906 Easy Street <br /> v ._._____ LO i SUBDIVISION )BLOCivLOr ❑Sanitary permits <br /> ' 6 Lantern Hollow I (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> r. <br /> .:ESrR P nor <br /> /Ve - v/ ❑ Zoning District <br /> ❑This project is a ffew building or structure. <br /> 0 Permitted Use? <br /> Minis project is an addition/alteration to an existing building or structure. <br /> r SER t, ._.t.. R tIT NUMBER 0 Rural Address <br /> I :ER EPTIC , (new/existing) <br /> .-,,,-,--1-..;-.7 �_ .. _ ,NUMBER OF STORIES (Not Including basement) <br /> 0 Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (O 's de dimensions including unfinished area attached garages and above grade decks or porches) <br /> __ .... <br /> j _ Erosion Control permit <br /> _.. .r_w. 1ST . <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> __--_ _- —.-___—__ — —_— filling/access) <br /> )R 3RD FLOOR <br /> 648.0 <br /> U Review Location Survey. . <br /> 1 I vtATED CONSTRUCTION COST i ♦ —* 50,000.00 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 ❑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? DYes ON <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 ❑No ODon't know <br /> 7. Is this to correct a violation? Efres IgNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> , <br />