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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME I <br /> KVAA �0�.45oN d' /�r,3-fi't. 0;7 An r° , Zoning Status; CUP; �/ <br /> OW RADDRESS (Number,Street,City,State,Zip) 4 Deed Restriction; CSM <br /> Sal /V ita Lane- M•'Ise(vwn , W1 c7Ce, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> og ' o 3okrt Sor► _ r an @ µe . G°^^ j Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension d <br /> AGENT NAME CONTRACTORINAME <br /> �d M NAME', <br /> - / (1L7'.c/J Met. /( ,....p04, ft g Si - �.-'---, ,sing locatio <br /> AGENT ADDRESS ( CONTRACTOR ADDRESS /�O : well/septi <br /> State,8 2 -6,-ti l4' I 7 p/*® �6 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> AA dcl (e_-6.-1 k- ll S-3Si-v <br /> PHONE PHONE Site Plan approval from , / <br /> o°. ,sir-- 6 ( 3 p applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I: 1,C9 VC, „Att- n Floor plans to scale /� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property 3 6 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> NUMBER 0-70t 0 (20(0 74 -/ p ,I 2 frontage drawn to scat <br /> TOWNSHIP: SECTION: <br /> 1(4 4atd (e--66,-) m7N potoo 1/4: N..) %1/4: Nc Driveway permit <br /> ADDRESS: (state,county,azill <br /> 31 A);,i... Lows e- frt id ert I r 4.11 l r3.12 v <br /> Sanitary per its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> , Sf (publi siisli <br /> PROPOSED PROJECT INFORMATION STAFF LIVI� E <br /> PROJECT DESCRIPTION: i,' ., ,' ,---‘ A x• <br /> $ i X 4 oh , ,� . �'. ,, � I <br /> �S ? `i Mktg[tstnct <br /> ©This project is a new building or structure. aPerrntttedU r <br /> ❑This project is an addition/alteration to an existing building or structure. „t <br /> Ifurr f*L <br /> SANITARY SERVICE: ASEPTIC PERMIT NUMBER:nSEWER (new ` 1 f <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) E <br /> / // et4III QWInf <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r, <br /> BASEMENT: 1ST FLOOR: J' � e,; Tr- <br /> 4, TOTAL SQUARE FOOTAGE: 4, t 5-. <br /> 2ND FLOOR: 3RD FLOOR: A <br /> ( z <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) -11. -• -• -• -• ♦ $ O o o O / `# �� , <br /> 1 t <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 g 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# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? El Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />