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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER JAME <br /> K= L Fa►2VK. LL ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Numbe treet,Cit ,State,Zip) I3e 2 6P 1 Deed Restriction; CSM <br /> I t q 4'7 N. DIVrI,.V R I�a7 r. variance(# ) <br /> HOME PHONE _ CELL PHONE E-MAIL ADDRE . <br /> °./► -.+1W WZ' - .8 -3444-272(i .64..m..1:6 •3 P. j •• ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ENT NAME CONT TOR NAME <br /> )E,Li Kit elsi62- `aS�.F ❑Site Plan including location <br /> A PA4 <br /> T ADDRESS CON ACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> UCCEATZW uJt S35 3 `f <br /> PH NE , PHONE El Site Plan approval from <br /> •314• 272 re applicable township. <br /> IL ADDRESS E-MAIL ADDRESS <br /> • ■ 3�yAiao.CQrt. ❑Floor plans to scale <br /> PROPERTY/LC/CATION INFORMATION (http://accessdane.co.dane.wi-us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: ^� CURRENT ZONING:A- ACREAGE: <br /> NUMBER 03.12-3Z 31-Q_)000 -1A-Z 2',*e es L� frontage drawn to scale. <br /> � QEZ-a.. , a �,C QEs <br /> TOWNSHIP: SECTION: •0 3139 <br /> ALB IQ 3z-s-12 '/4: s W '/4'4: 5w ❑Driveway permits N A <br /> ADDRESS: T . (state,county,town) <br /> (1947 t\1. . LOt4.3 0)46 FJe-C-fe aN, (A SS 3 4 ❑Sanitary permits N A <br /> CSM: LO SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> pan.IF�.gT DESCRIPTION: <br /> 1SCA-V r-) — -C-c1.4. _ CI Zoning District <br /> This project is a new building or structure. ` ❑ Permitted Use <br /> ISIThis project is an addition/alteration to an existing building or structure.' . <br /> SAN Y /�ERMIT NUMBER: ❑ Rural Address <br /> � .. T (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> &'A API t I S'4'. Tb f AK- ❑ Wetland/FloodpiaiM <br /> AREA TO NEAREST SQUARE FOOT: Sh©reland (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ' 2 85 SOFT <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q� OO 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? ❑Yes igNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes in o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <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) Dies No ['Don't know <br /> 7. Is this to correct a violation? rites ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -► <br /> 545-112(4/08) <br />