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, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> akbV td LLC, TFwI `2 v ❑Zoning t ,, <br /> OWNER ADDRESS (Number,Street.City,State.Zip) Deed I t <br /> �q q li Lao./ i2. (A • O v�o l v • S '&5" 7--;-5 Varia c # <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> •r :- i r a , 0.1e k". •e •yes K • . to Plan drawn to sca e <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes ime ons <br /> AGENT NAME CONTRACTOR NAME <br /> -0A,(a„11 T. 0, ),...s, p Site PI n' uding location <br /> AGENT A RESS CONTRACTOR ADDRESS of well ptic <br /> S OVtJA 0.4> ,Jab V G— <br /> (City,State.Zip) (City,State,Zip) 1'I Setba <br /> PHONE PHONE ❑Site PI ap I from <br /> appli t s p. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> loor plans O s <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [�'1=jevation o pro rty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑N EL C 6 i!6 - o a-8000-3 A ( G x 8 Q frontage dr to scale. <br /> NUM UM BER <br /> TOWNSHIP: SECTION: <br /> rA Vl Vl '/a: '/.'/a: El Drip is <br /> ADD sS: (slat <br /> ')1 q.1 L e-1 o" R S • <br /> CS : LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) i e <br /> PROPOSED PROJECT INFORMATION -AFFW <br /> PROJECT DESCRIPTION: <br /> 4 v a o._,, ❑ Zoning trio <br /> . This project is a new building or structure. ❑ Perm ? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Addr <br /> EWER 'jtEPTIC (new/e a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 4 <br /> CI wtir„*. :,„- ,,—, ' i <br /> k` RREA TO NEAREST SQUARE FOOT: S t) LJd <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit FG <br /> ,•q # j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Revi U>�Sywey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ -► $ _�A d.00 D , and a� i ns. <br /> (Please round to nearest dollar) r 'ti <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ZNo ['Don'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? 'es OW <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) [Yes �No ❑Don't know <br /> 7. Is this to correct a violation? Eves QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ <br /> 545-112(4/08) <br />