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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> KA4c QI0d <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status;CUP; <br /> .341 69(4 Sf,, /'44 Allyn, L✓ - 53 7/3 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E AIL ADDR .S Variance(# ) <br /> ceo1- 3`f4 S c <br /> -M l ... 0,Kea Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mike DAnt nger 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> H SD(, 0/014/4y ?MI <br /> (City,State,Zip) (City,State,Zip) <br /> ❑Setbacks <br /> /4AAiio n t �„ I_ 51/1/ <br /> PHONE PHONE <br /> boy "'I 331 q 0 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Iha+di4n rr9¢rti �j'AM ir ael 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi•us/) <br /> ElPARCEL <br /> PARENT PARCEL NUMBER: p CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> NUMBER 0 7O 9 1 S/7 p qt0 1�13 0.6 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 4 el lion 1/: 1/41/: 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM' LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> s ! <br /> 0 Z <br /> • '�` his project is a new building or structure. <br /> C:I PerMitted We <br /> "d► his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U <br /> EWER DEPTIC <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not induding basement) <br /> Wattandftrattdalol <br /> , <br /> AREA TO NEAREST SQUARE FOOT: hli <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 <br /> BASEMENT 1ST FLOOR: , <br /> TOTAL SQUARE FOOTAGE: 4, otopesiAstwbance, <br /> 2ND FLOOR. 3RD FLOOR: <br /> /3 <br /> ESTIMATED CONSTRUCTION COST: Q tVitt .0�', ll1VBl <br /> (Please round to nearest dollar) '► —► —► -i —► ' $ a 000 <br /> � . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes Oslo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes o J)on't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ (]Yes Llo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes aJo <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) QYes lab ODon't know <br /> 7. Is this to correct a violation? [ Yes ONO <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► —► <br />