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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> K a) PID Je lea Lee ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (dl51 'Ph r I J_C'LOIt S w h ' Mi Lttd -O u (.0; 5 3 56 s. Variance(# ) <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS 1 <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ■TohN CT c? &hhirer TA-g0/4 Sck(Lite r Gust•LL( Site Plan including location <br /> AGENT ADDRESS CONTRACTOR�A DRESS of well/septic <br /> 12445 DAkuMez Cir-cle. gol5 IN br. <br /> (City,State,Zip) / y� (Ci ,State,Zip), r ❑Setbacks <br /> PHONE T""1 t N 1 Ur 539 2 PHONE t �t, 535 77 <br /> ❑Site Plan approval from <br /> 662 Pilo - �90/ 6ea 5 7V 3617 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> °. , ter er ever J'�•Mmstf�i'dm4'( grTer. /Ter ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN-ZONING: ACREAGE: El Elevation of property <br /> ❑NUM ER O 208-35t-ao3y -7 frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> 1p r•u g-C;.e1 d Nus3 %:5 t '/a'/: io'f Driveway permits <br /> ADDRESS: l� 3P6 (state,coun , o , )' <br /> CSM: L0-r 2i -LOTC he rr`� g t-i i SUBDIVISION t (A Rote BLOCK/LOT COO rr u"anitary permits L� ' i <br /> (public,private) I <br /> `� C Kerr {�,!I <br /> PROPOSED PROJECT INFORMATION r� <br /> PROJECT DESC�PTION: � t euSfruct a Jew home <br /> . his project is a new building or structure. t ? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 <br /> EWER VIEPTIC /3- aoi$ - (503a 1 a6 ' .) <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) <br /> Q 4)- 1roi , <br /> AREA TO NEAREST SQUA'E FOOT: <br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches)- <br /> BASEMENT: 1ST FLOOR: <br /> 1 q 15 <br /> / i 3 3`31- j TOTAL SQUARE FOOTAGE: j ,,• , , <br /> , <br /> 2ND FLOOR: 6^ 3RD FLOOR: I <br /> — 56). -C <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ $ + o _ " <br /> (Please round to nearest dollar) 535000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the pro•-rty? ❑Yes o �on't know <br /> 3. Have you talked with the township about your proj;ct and are they in agreement? ®Yes Lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years . '' [Yes glNo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# 15 1 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Ilo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes alo <br /> , I/ APPLICATION MUST BE SIGNED <br /> 545-112(4/08) / 7 I y t I /1, roc P (Continue on Back) -∎ -i -► <br />