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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 /> KA/I"-.'+-K Al O a.(�E'1/1•La/l/i.Pt_, ❑ Zoning Status;CUP; <br /> C`'/OWNER ADDRESS (Numbbeerrr,Str, et,City,State,Zip) Deed Restriction; CSM <br /> HOME PHONE �E CELL J NE d MAIL !S _63-57-5— Variance(# ) <br /> hok� l 1't'+ G S'9t aeY(' Keel ocreerrwn a0-w,G r(- C O rn ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME I� CONTRACTOR NAME <br /> Tt‘e.- CD 4-LC 1 I. To-i of k4___Te,.e_ C' L LC- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S:9 Ind, <br /> City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Fite-l-Ju 7 WI 537/1 <br /> PHONE PHONE ❑ Site Plan approval from <br /> toDE- (9g5'341'7 applicable township. <br /> E-MAIL•I..RESS E-MAIL ADDRESS <br /> tkirPSVen-4ketelti , e ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT-ZONING: ACREAGE: <br /> 0 PARCEL a,�8 (0 A _3 A �7 frontage drawn to scale. <br /> NUMBER <br /> V TOWNSHIP: O6/oo1106450S SECTION: ❑ Driveway permits <br /> )iw Vn(IQ '/4: /� %1/4: /0 E (state,county,town) <br /> ADDRESS:sSi, La (or .Q4, O '•-`e9v, 0( _535--7__G---7__G--- <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> u- * AFF EW <br /> PROJECT DESCRIPTION: F <br /> AAA;-,e ed�sF�. y fat -u� ©u w/ t t N ,7 <br /> � <br /> . ❑This project is a new building or structure. LiP�ed U <br /> This project is an addition/alteration to an existing building or structure. fb 'y <br /> Ru dry, w=4.4.1 <br /> SANITARY SERVICE: ,�, PERMIT NUMBER:^ <br /> E1SEWER ��SEPTIC 1 '-QV S''OOOq -o / ting <br /> HEIGHT IN FEET: d�, A J\ NUMBER OF STORIES: (Not including bas ent) <br /> ; h�a I# <br /> AREA TO NEAREST SQUARE FOOT: 9 ; <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) f 1, ®r • t, ' , f <br /> Oi permit <br /> BASEMENT FLO R: <br /> -5g„p„r ga <br /> 7 3 h9Q <br /> g 1 TOTAL SQUARE FOOTAGE: 4, , ,-,( • s €I a p, f, <br /> 2ND FLOT: "'l� 3RD FLOOR: �� �-+i <br /> �v1 <br /> !I/ -� �"�' �l0 Inc, 'V Location Silk*: <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ '�'�(1 a t �C �. <br /> (Please round to nearest dollar) P a""' !A; ,,;,,. *. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes TNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes 'tlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1Ces ❑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) Eyes Z,No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes `RNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />