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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> akr- kw r ed 1 Y °t e_ri ^ 4) <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �� ❑Zoning Statu • CU <br /> - T Deed Restric o , CSM <br /> 445-0 " Co y J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4' Er, na+Td G wan-rct, ❑Site Plan draw to cafe <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di nsions <br /> AGENT NAME CONTRACTOR NAME <br /> WS 1 \ O( '3 Inc ❑Site Plan in I Ing location <br /> AGENT ADDRESS CONTRACTOR DRESS QQ of well/septi <br /> (City,State,Zip) (City,State,Zip) .--,0111 El SetbaL�ks <br /> Q r <br /> PHONE PHONE ik ❑Site Pla,/-, ,r I from <br /> (off -3 Lb— 6 611 16 M�f"ell applica',I- • <br /> p. <br /> E-MAIL ADDRESS E-MAIL ADDRESS X‘IV <br /> ben etr • m,NT c, p(j ❑Floor plans tev6ie <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 'C AGE: ❑Elevation of r0 y <br /> ❑PARCEL <br /> NUMBER 0-7 0",--< I. - : S(151� f'a„ t. �(r frontage dra o scale. <br /> TOWNSHIIp, SECTION: <br /> 1 <br /> L" S5 Y((ti; ` '', _ .1/4: • '/4'/<: i ❑Driveway e�� <br /> ADDRESS: (state,co n ,><o n) <br /> CSM: LOT` SUBDIVISION BLOCK/LOT ❑Sanitary er Its <br /> (public,p . te) <br /> / <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A/e 1n1 l4 6 4.S� ❑ Zoning District 6 1L <br /> aThis project is a new building or structure. ❑ Permitse. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT ❑ Rural Address <br /> [EWER ,*EPTIC k,-—� l l® "0«(J 6 (new/:iiii72) <br /> HEIGHT IN FEET /► _ // �'t i NUMBER OF STORIES: (Not including basement) <br /> �[�V�� ❑ Wetla ,• ;.dplain/ <br /> �-� AREA TO NEAREST SQUARE FOOT: <br /> ShOr=- . achment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I-1 Erosion o,trol •ermit <br /> 3 1 !J ! 7 ;Xi V.4, TOTAL SQUARE FOOTAGE: j (slo• s •ante, <br /> 2ND FLOOR: 3RD FLOOR: I Min. = SS <br /> ❑ Revi- , ■ .-tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and - , �=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? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes g o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes •: o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'es 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) ❑Yes nvo ['Don't know <br /> 7. Is this to correct a violation? ['Yes WNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) h♦ ♦ -► <br /> (,t.vt '& . 7 ( 1 <br />