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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App it <br /> PROPERTY OWNER INFORMATION Cu TO ER TO PROVIDE <br /> OWNER(NAME <br /> 1 114&04,\ Se,ksi %\"c <br /> OWNER ADDRESS(Number,Street,City,State,Zip) 11 ing Status;CUP; <br /> 411 �., hoh ���` Wla�:wn D ed Restriction;CSM <br /> . w1,. 6- A Ve riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,.1. CAS :33Z. ; _ _ ; Vqg 'v.,w;t .cow, ite Ian drawn to scale <br /> AGENT INFORMATION !CONTRACTOR INFORMATION n includes dimensions <br /> AGENT NAME •nAgitirt.r./Sitro CONTRACTOR NAM E <br /> �b'^y mast. ;rttri Lt‘t••dary VIOwlcs x LLG Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADORESS f well/septic <br /> WO C,xf.t.1 ot• knot_ 05000 C7.xceaS10 c bc,Jt <br /> (City'State,Zip) (City,State,Tip) Setbacks <br /> VAaeisan t toil- S.5411 MIatki SoTAI Wi S3'4.1} <br /> PHONE PHONE El Cam, $Z9 - S000 Ste PI approval from <br /> bog A 9000 pli ble township. <br /> Ahets.,,3@ E-MAIL ADDRESS E-MAIL ADDRESS <br /> Pi*i■ G L ' • ' bw.t-t..corn --,H n 1 ,c,,,c(*,,, a4;i} taw, 10 plans to scale <br /> ,bµ; PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.v.i.us/) <br /> PARENT PARCEL NUMBER RII Z ING: ACR E: ` E vation of property <br /> ❑PARCEL ,, I f age drawn to scale. <br /> NUMBER 01 It -033- by3o -8 1 g <br /> TOWNSHIP: SECTIO T <br /> r✓ �nrov L 3 'h: S W %h�4: D iveway permits <br /> ADDRESS: n ^T` tat @,county,town)I <br /> Kt n 'r k s Sanitary permits <br /> CSM: 3`OO LOT UUDIVISION BLOCK/LOT ry p <br /> 3 public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> I. oning District <br /> • 12rThis project is a new building or structure. Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q� - I ' 'dress dress <br /> EWER EPTIC /3 OP ..Q do/Y1>r (new/- ;sting) <br /> HEIGHT IN FEET: I NUMBER F STORIES: (Not including basement) <br /> / I ❑ Wetlan plain/. <br /> AREA TO NEAREST SQUARE FOOT: Shor d (efts nt) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErDSion trot permit I S'$o 2.0°14 ,j TOTAL SQUARE FOOTAGE: + (slo ,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: f g/access) <br /> ti '11 <br /> '4,4 16 m <br /> ESTIMATED CONSTRUCTION COST: CI and Location Survey <br /> (Please round to nearest dollar) -ii. -I.- - -I.. - -► $ y LAO O0 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ges go ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes M <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan/none) <br /> 6. Is a location survey required? (see reverse) ❑Yes V, o ❑Don't know <br /> 7. Is this to correct a violation? :Yes 7 o <br /> APPLICATION MUST BE SIGNED <br /> 545-11 (4 (Continue(Continue on Back) -► -e -0 <br />