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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> 11'l:kt awl l" lky 04. 1 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) A / Deed Restriction; CSM <br /> rosy 7;,nber Xa„e (,toss Plan„ s A) ! 5352 8 , variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> &DS 2z5—il'bO doff 225-170 V & H,/ee„ ;o,/l&Aoti,•,a• jl Cc*1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRAC fOR INFORMATION and includes dimensions <br /> AGENT NAME a Kci. j3c/I. CONTRACTOR NAME <br /> A.cKe/ 44.c e/auc,•Ne,„.I- 5e ktr Ame r;:opro()e0,t. -1- ❑ Site Plan including location <br /> AGENT ADDRESS / CONTRACTOR ADDRESS of well/septic <br /> lb g y 4 <br /> g4ti a -e 2n ic i3?af,ti Xaf+4 <br /> (City,State,Zip) (C�i ',Sta e,zip) ❑ Setbacks <br /> 671/4)e. �ry Wl 535? 7 CO . ("Pvas GJ1 S3 s27 <br /> PHONE- PHONE ❑ Site Plan approval from <br /> $ 212- 3$3 e 6,0g 2,2 -3S 3'' applicable township. <br /> E-MAIL DDRESS 1 E-MAIL ADDR SS <br /> fa yVb<<kp/A004< <�'`('-uu '"NA,t rawdy@ 6cktrkoMe;"'Prcx,nee+-ft6-1.'.❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL MBER 63$/D?a8-653' 7y4 5-0 frontage drawn to scale. <br /> NU <br /> TOWNSHIP: SECTION: <br /> /nA dc//e iv.-1 18 1/4: 6 i %oh: :-.5k/ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4405' j en btr A e <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> tf l gVS— 2- (public,private) <br /> PROPOSED PROJECT INFORMATION .REVIEW <br /> PROJECT DESCRIPTION: Add a deck S -lo (net.-SQ4 <br /> D ding'Ostia <br /> ❑This project is a new building or structure. S'ed Use? <br /> Petxnilte! <br /> ®This project is an addition/alteration to an existing building or structure. <br /> � . . <br /> SANITARY SERVICE: PERMIT NUMBER: '`" , <br /> SEWER 171SEPTIC '11740W/ ' i <br /> HEIGHT IN FEET: NUMBER pF STORIES: (Not including basement) <br /> 0 <br /> � / (1 U Wetla d Fl dpletini <br /> AREA TO NEAREST SQUARE FOOT: $h�8nd' CilMen) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ', <br /> BASEMENT: 1ST FLOOR: <br /> ' .` <br /> 7 53'06 TOTAL SQUARE FOOTAGE: r dune, <br /> I <br /> 2ND FLOOR: 3RD FLOOR: fdhrlff ' F <br /> 50.c00 ;... <br /> L pv*W',t4eatfcirl Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ,♦ ♦ ♦ $ ��ap p c,U and b options` <br /> (Please round to nearest dollar) �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 1: • o ❑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 ONo <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 />