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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME V / <br /> J as o n Kon Z Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM tr <br /> 3750 C(eS4V'lew I�r. Cotay Gir .,ve1 L. 53521 Variance(# �� <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (90 31-0390 q20 -723- 1311 .3konz73© grnaI.(i)rn Site Plan drawn to scale 0 <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions , 60 <br /> AGENT NAME CONTRACTOR NAME <br /> [Site Plan including locatio 4 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic 0 <br /> (City,State,Zip) (City,State,Zip) ZSetbacks 30/15-(O <br /> PHONE PHONE XSite Plan approval from <br /> applicable township. 4- <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> EZFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) / <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> 0 NUMBER 0 i i 101 i I -213-1-1902-1 R;( DCPM1CZ'0000-0 frontage drawn to scale. <br /> TOWNSHIP: SECTI I <br /> 1 r�aw�Cr (at f ive f 07N; jell L2i ' 1/4:, 51►J 1/41/x: SW XDriveway <br /> county <br /> ADDRESS: (state,county own <br /> S1&o cvf ,,k, b co�Gste, CI"..,t. (o i 53SZ1 <br /> anitary CSM: LOT SUBDIVISION BLOCK/LOT <br /> 213 y 30 1-re., skill i,I,, y �Ael,'∎ v, LI Z (publi nv <br /> ' s <br /> PROPOSED PROJECT INFORMATION STAFF REVIE <br /> PROJECT DESCRIPTION: ,` <br /> P r ktn�' �o�'er 2 x �t Jx t o S S�0'4 -c 4 v Zoning District "//'� <br /> . [ This project is a new building or structure. - J <br /> 1 , Permitted Use? c, <br /> ❑This project is an addition/alteration to an existing building or structure. .t, <br /> SANITARY SERVICE: PERMIT NUMBER: RUraI.A <br /> EWER PEPTIC (new/ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10 ' 1 ,Wetland/Floodplain/ , <br /> AREA TO NEAREST SQUARE FOOT: horeland (attachment} <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> 21 it 21 / 56 6 4, TOTAL SQUARE FOOTAGE: 4, lopes,disturbance, 70 <br /> filling/access) I <br /> 2ND FLOOR: 3RD FLOOR: r <br /> (O -r{2 Review Location Surveyaf <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options, iv <br /> (Please round to nearest dollar) $ 9 O v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves [ No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves gIN o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Y s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑No <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) es iNo ❑Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 - <br /> 545-112(4/08) <br />