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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER VAME <br /> Ks L ra'2rk L1 n Zoning Status; CUP; <br /> OWNER ADDRESS (Numbe Street,City,State,Zip) <br /> I q 4/ N. Q,(„I4'11 440 <br /> Lt <br /> IL F. C) c 2 �P r1 Deed Restriction; CSM <br /> D Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRE15'' I� �-y�J�, <br /> WaPLR'o0 WI' - •$ •34(i 7241. "VA�l+�•Vo 63�"'Y 1 e ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ENT NAME / CONT TOR NAME <br /> WI O.- k'Q 2.G'�.- <br /> SC— ".- El Site Plan including location <br /> A NT ADDRESS CON ACTOR ADDRESS of well/septic <br /> 1 19'41 1.1. 1i15.0 4tAN I � . A s.k E !4C A .i r <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> tfiar:n-Tb 0/ ter 53531 <br /> PH NE PHONE n Site Plan approval from <br /> 8 -3/-(,,- 27 2(e applicable township. <br /> ILADDRESS E-MAIL ADDRESS <br /> Pk• ■, 3C `))/,■({pp,Corti- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION '(httpelaccessdane.co.dane.wLus/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING:A-I ACREAGE: <br /> PARCEL 0 S 12-3Z 31-9000 -')'A-2 DCPRE 229 2-VO Ae.ees O� 10 ACR. S frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: — D 3134} <br /> ALait. NI 32-5- 2. 1/4: ...%(A) 'AY,: 51,0 ❑ Driveway <br /> , countpermits N <br /> ADDRESS, A (state, county, town) <br /> (1947 r . Io.L&t4 rbAL EO Tom, for 53�T <br /> El Sanitary permits NI/q <br /> OEM: LO SUBDIVISION BLOCK LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> but IL � �e ov °Lo CV15+/'��Nca' ❑ Zoning District <br /> . EiThis project is a new building or structure. �It2gL O►3 oLp SLA-a ❑ Permitted Use? <br /> I NThis project is an addition/alteration to an existing building or structure. <br /> SAN Y E / PERMIT NUMBER: ❑ Rural Address PTI� � (new/existing) <br /> HEIG"T"'FEET: NUMBER OF STORIES: (Not including basement) <br /> ^- ^^4. ,fd! 1 - _ t'. - / ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AKEA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: 1 (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> e.i so.rte-. <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: QO and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ $ 50 c <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Res ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes /►• 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) [Yes NNo ['Don't know <br /> 7. Is this to correct a violation? 'es ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4)081 <br />