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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> Nara c' Ai rSon .- �J rail ?Yk.(orrn lL <br /> LI Zoning District <br /> OWNER ADD ESS (Number,Street,City,State,Zip) <br /> 8S-11( e ilit fintool, p cacilc tn,kii S3S4,3- <br /> PHONE E-MAIL ADDRESS LI Permitted Use? <br /> &clic-8' 33-If9b <br /> AGENT INFORMATION CONTRACTOR INFORMATION Li Deed Status;CUP; <br /> AGENT NAME CONTRACTOR NAME Deed Restriction;CSM <br /> /v yor <br /> Latc!✓cAce CasA,,. Coast• Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 7 /r�cuvud C."r c4J LI Site Plan drawn to scale <br /> /o t v <br /> (City,State,Zip) (City,State,Zip) <br /> includes dimensions <br /> PHONE P ES I °/ ii s kit 5354' ❑ Site Plan including location <br /> 40.01-79Y_ � ofwelUsepfic <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LI Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: ❑ Site Plan approval from <br /> ❑ PARCEL applicable township. <br /> NUMBER V3fs1070e-d 51-01/14-0 A-/ <br /> TOWNSHIP: SECTION: <br /> middle full OS 'A: NC. '/4'/: No,/ <br /> ADDRESS: Address <br /> ADDRESS: (new/existing) <br /> 35/X(///rtj Fun lt-bymIddcdlehrn 4..+ <br /> CSM: LOT SUBDIVISION -BLOCK/LOT ❑ Floor plans to scale <br /> S/o Sb>zCbrauk FS{ (e1 <br /> PROPOSED PROJECT INFORMATION ❑ Elevation of property <br /> PROJECT DESCRIPTION: frontage drawn to scale. <br /> De fact,ec( 1 4ray acid n oti <br /> _,/ - CI Driveway permits <br /> W/This project is a new building or structure. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Sanitary permits <br /> ❑SEWER -SEPTIC (public,private) <br /> HEIG IN FEET ( NUMBER OF STORIES: (Not including basement) <br /> (0•�p LI 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: i'L g ❑ ErosionControl permit <br /> Uj TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> LI kv <br /> ESTIMATED CONSTRUCTION COST: h <br /> LI Review Location Survey <br /> (Please round to nearest dollar) "� '► -► -► -► $ (7-4)I Ud().t)U and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ❑No LikiOn't know <br /> 2. There is 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? ales ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes LI No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if non- <br /> 6. Is a location survey red? ■ Yes ❑No M Don't know <br /> 7. Is this correcting a vio - 1.. . ❑Yes r o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(1 ) (Continue on Back) -a- -► -+ <br />