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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 /> KOWAtICif 6vA 414-W0 ❑Zoning Statu • UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Re ' tion;CSM <br /> 90 5 MAe/so.✓ S 14 c, e,-f„ (--/Z 5-3s-e_3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A/DDRESS <br /> 3 70- .7 5-7 7 0 Site Plan drawn tp scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes 8+rfiensions <br /> AGENT NAME CONTRACTOR NAME <br /> A/6 'SE i‘ lAii s I),./c. NsAisi-,v dv///cams In., . ['Site Pla incc i ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/spifc <br /> //0 gRkELn. Sf. St//L /3 //d 13if.El,-1 Sf. Svr4 t9 <br /> (City,State,Zip) (City,State,Zip) Set s <br /> t i'A/A 0 A- f..- & -. S 3 5"%.7 ,Gf/A vti A A4 e f �,..7 5' ? s i 7 <br /> PHONE PHONE <br /> ❑Site Pla ,ap I4 om <br /> j '60 k-e ta - e/7.7 ‘: G o --- k r-- 5/7 .x; applica• - • " p. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ER/st-U 6 w/aif,r s /. 1- ç.N$r `jEN3E.v b v�/dek s 7;05 , .vz T ❑Floor plans ta,s�ale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> 0 PARCEL PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation oferty <br /> NUMBER 0 907—/ 3 -po GI frontage drawn to scale. <br /> TOWNSHIP: / /, 5 / <br /> �} SECTION: v <br /> /�o K v z NE '/<: S w %/,IA: ik Driveway permits <br /> ADDRE(S�S: �r- / p f (state,county,town) <br /> 9 ` CJ ,C>/At rAwk 'eN// <br /> CSM: LOT SUBDIVISION BLOCK/LOT - ❑Sanitary permits,j Q r r <br /> 7 C-73 Z (public, private) L41-(V7�`/' <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NF ttl S,r••y /8 1„ , /7 ,Q,-s,4 ,u,,, E ❑ Zoning District i <br /> ©This project is a new building or structure. ❑ PermittedTJse? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI R I Address <br /> [EWER PEPTIC / 3 - ,2O/r 001 7 0 /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,2 G ' / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1-1 <br /> ErosionControl permit <br /> / ¢S/ 3 /oZ ,, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/ac eSS <br /> V 9S-3 0.0 ❑ Revie ati0 ey <br /> ESTIMATED CONSTRUCTION COST: and ava ' n5-. <br /> (Please round to nearest dollar) ♦ -0 ♦ '♦ '� '♦ 3 �0 D p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ['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) ∎l∎es ©No ['Don't know <br /> 7. Is this to correct a violation? QYes QNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -♦ <br />