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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 /> ��L1 KAft■S 3)UUM X ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 4900 1-1-1414 G1-1'� tKAL MA4 r LL 1,31. 53551 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> -574-6469 /26&—112- r?g j gT1JuMK. - L)V)• CoM ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Z g DMe G= fiZe 1$Y �bWA-Zt> TT-1,,, ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 43Z, F IJST A Rbhb 4--7€ 14 1(..a-_Tor i vE <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> M ►AL., L J 1 9359 MP,c3t)f.) ,1-01. 53711 <br /> PHONE PHONE ❑Site Plan approval from <br /> 1008- 347-4748 b - 444..- Mot applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -Er.�,,(mIb`1 L° •MAIL.C,ij E$R 'TTt,1 Ce e c171x5 +i.. S 1 ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL O$1Z-331 -49oo-Z, to --ex _ gzao frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • 61,1LIA '/4: '//: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT L1/ ❑Sanitary permits <br /> /� 7 J (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> FANI I LI Rijort hbDt-11o1J W" tJ ».31 $A a-maKIT ❑ Zoning 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 SERVICE: �-,[ PERMIT NUMBER: ❑ Rural Address <br /> EWER IXGEPTIC (new/existing) <br /> HEIGHT IN FEET: I YY �� NUMBER OF STORIES: (Not including basement) <br /> 26 1 LI Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> 1 )4 Ip.-4w X Zo'-0 19 14 u x�T t„�� 4,, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: — 34� 3RD FLOOR: filling/access)3 -1c). ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ $ , and available options. <br /> (Please round to nearest dollar) 'c, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves 1SINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yeslo <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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes , o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -♦ -► <br /> 545-112(4/08) <br />