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'll► ( c51 ,(07 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ..)CC\-Pt\VA. V. - (4 -, : '-N ❑Zoning Status; UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restri ;CSM <br /> "42-44 , 1 u, S�15 Variance(# ) <br /> HOME PHONE CELL PHON E-MAIL ADDRESS <br /> 54- $12-2-, ❑Site Plan dra n scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes E Tnensions <br /> AGENT NAME CONTRACT RNA <br /> n� e , /L ❑Site Plan includtngTocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic VV <br /> ?2 q 1 `e-- <br /> (City,State,Zip) (City,S• e,Zip) ❑Setb4c4 <br /> L_ t• ( —`3 I'6/ <br /> PHONE PHONE ❑Site Plan a, % ://t..... rom <br /> 60 -617---5616 applicable to hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> b yw J 44 PJ r2-4/4:CDC ) ❑Floor plans o scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) ❑Elevation of propy <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER 052- A- ( 3'` <br /> TOWNSHIP: SECTION: <br /> KU-N` W1 60 1/4: C 1/41/4: 6E_, ❑ Driveway(state.cou <br /> own) <br /> ADDRESS: <br /> 42— J _ kVIN 1 ❑Sanii: „ ,4, mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public. . iv.te) <br /> PROPOSED PROJECT INFORMATION STAFF IEW <br /> PROJECT DESCRIPTION: <br /> t i a ,l _ _ LI Zoning D ct <br /> . ❑T • project is a new building or structure. 1.3 Permittee? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (neW/e S g) <br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) ��!!� <br /> IS'-V •(�2�'I ❑ Wetland/F ...•,,in/ <br /> Shoretan,Wtt ment) <br /> --AEA NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionC•i,'of !"rmit <br /> BASEMENT: 1ST FLOOR: <br /> 1086 4, TOTAL SQUARE FOOTAGE: 4, (slope; •i° •ance, <br /> filling/.,c ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 10V <br /> ❑ Review i_ ation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ A � and' able options. <br /> (Please round to nearest dollar) $ '�{ r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 12fC ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y s to ❑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 126 <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) Oyes [iNo ❑Don't know <br /> 7. Is this to correct a violation? Lives to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ -i <br /> 545-112(4/08{ <br />