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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> MINIM <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> O ER NAME <br /> q and i ,sa ar&&V iQ E/, Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ) / Deed Restriction;CSM <br /> �P PHONE y sC ce - , (sc�I 6 35 33 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRE S v <br /> i (o-f3`37V , . 9W--b`3L • - `i b 0) fl' -1'1.(,_p L,riPo,'. : Plan drawn to stale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION , ,end includes dimensions <br /> AGENT NAME CONTRACTOR NAME Kiel R ADDRESS of well/septic <br /> CZS1 Y1 ) J Site Plan including location <br /> AGENT ADDRESS CO CT <br /> Woo L.ue-ii1 <br /> (City,State,Zip) (Ci State,Zip) Setbacks <br /> .(z u-K Cifi (,�, 535 g.3 . <br /> PHONE PHONED t ME Site P . a 'J from <br /> (POE (, Y3 -Lf 39 appli.- . : . nship. <br /> E-MAIL ADDRESS d Vo ii;Lv G/_oo E-MAIL ADDRESS <br /> U (IQ IJV EfiFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) W Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONIN : A E GE <br /> 0 <br /> _ ' <br /> frontaa rawn to scale.NUMBER AM-idyl -�s' - .. i of. • <br /> TOWNSHIP: (� SECTION: `" t <br /> d`�(�i.�l 't 7 '/� vV 1/4'/4:�O Ai %rternlits �j�(/t.' <br /> ADD ESS: 1 (s ty,town) <br /> • <br /> el <br /> GG <br /> CS LOT � �SUBDIVISIO BLOCK/LOT ts 0\ <br /> ) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIO . , ek to 0 C tt,,'V\ v /QQck Su R f' yjp'► r ping District <br /> 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 SER�EWER �EPTIC P�MITNUMB�OI� �O© (�, ❑ �� Address <br /> 3 /y� existing) <br /> HEIGHT IN FEET: (` 1 NUMBER OF STORIES: (Not including basement) <br /> A Wetland/Floodplainl <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area attached nn`` ages and above grade decks or porches) Q it 1 <br /> BASEMENT: 1ST FLOOR: C/%' <br /> a-P 023 1...5 ..a ft t% <br /> x + TOTAL SQUARE F E: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: � j �' filng/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ !� 3 1 - . available options. <br /> (Please round to nearest dollar) q�4 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? aj ,-s in. QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? f es Flo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? I Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Liles Zitsio <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) cJ`!es EtNo QDon't know <br /> 7. Is this to correct a violation? QYes [ Jo <br /> 4 5 14. 7 0 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -* —► <br />