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I. <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 33 s eph �Loreh Ka(5cAe ct r 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) r Deed Restriction;CSM <br /> 9 / $ ��'S h � r 1 'd.. w4tt keE �I S 35R7 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS t <br /> 47tg '31 -8` i& " 46 /i/-0 b /Kalsch e_u i- re's , /YET Ley Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Oa.hi e/ Ka/s c he u f<seii J ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) <br /> (City,State,Zip) [Setbacks <br /> PHON o �� a �g - a33 ( appl icable[Site Plan approval from <br /> PHONE lcable township. <br /> � <br /> E-MAIL ADDRESS E-MAIL ADDRESS Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane-wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: <br /> y�1 CU ENT ONING: ACREAGE: frontage drawn to property scale. <br /> [NUMBER v e1J nl1 d�� Z�°c'SSU O , � <br /> TOWNSHIP: SECTION: Driveway permits <br /> S r t, �} r�e(� '/,: W.: (state,county,town) <br /> ADDRE S: <br /> LA 1 g LA ? (L ! Watt,n e i(e e- W 1 515-17 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ‘za ❑ Zoning District <br /> /D / X //f / t eG ,w;, <br /> . [This project is a new building or structure. VI" 9, ti%\c ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. 1 u�l Address <br /> SANITARY SERVICE: PERMIT NUMBER: d�C�� (new/existing) <br /> EWER EPTIC t` G� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding bas tt) ❑ Wetland/Aoodplain/ <br /> I �' Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: r.,\''' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -4- 0 O O 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? fYes WNo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> es ao [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ENo <br /> lea <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> es ow [Don't know <br /> 6. Is a location survey required? (see reverse) L�r <br /> 7. Is this to correct a violation? [Yes [ to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -* -'► <br /> 545-112(4/08) <br />