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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIIN <br /> OWNER NAME <br /> D,vitO 13 K-hro r r Zoning Status;CUP; L <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM r <br /> 110 t L 6 K-t= Ov - v2-0 . Variance(# ) 7 7 y/ <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> t)IS a�tc-113-f a br kit.QSYx- °Iob4,tie t <br /> i4 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME L� <br /> PteAnyn l�i r(l�ur� S1rns l;�c i d-'Rt:rn0OtLln.k, I:4Jc . 'Site Plan including locatio G�J <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 10o 130 7 eb 3ox - /� <br /> (City,State,Zip) (City,State,Zip) Setbacks t0 06 2c/I <br /> Ca i r 1 v 1 S3S') ) Coi'V■pc,C Gt lech, , wt. S3 S a� �0 <br /> PHONE PHONE Site Plan approval from <br /> (e 09 7 3S--Q '�5 (16V -S 3S--03'15 applicable township. Aj�� �0 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> AAroit 5tIAS(2 f)06- -r erywQ 51ri5e.xfrr loci.net p-Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �XElevation of property / <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: e P perty � 4,(" <br /> El <br /> PARCEL 65 55 (..7 frontage drawn to scale. <br /> NUMBER a f os l0 113-43,-00-r-7 <br /> TOWNSHIP: SECTION: <br /> ak.a.A-40 I I 1%: 5w 14 : sus) Nf Driveway permA <br /> ADDRESS: (state,county, ow <br /> II0I LAKE tC-etia,A-e49 51b0tiitity•-), ' .— 6 3596 till CSM: LOT SUBDIVISION BLOCK/LOT Sanitary tS <br /> U70 9 l I (publi rivate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / /) / ^ a <br /> F,eon)T PORA-1+ F g OELK- CD v F4 fo r Op <br /> �''— �7oning District fr`�r(,�,( r/,/ <br /> ❑This project is a new building or structure. >Q`e C�` �` <br /> Permi-tedUse? <br /> This project is an addition/alteration to an existing building or structure. A /4(K 'r g S rk <br /> SANITARY SERVICE: PERMIT NUMBER: X Rural A. - <br /> EWER JEPTIC (new <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ���� <br /> a% 5 11 i ) lw/ <br /> Wetland/Floodplain/ <br /> Shoreland (attachment) E •r' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) flit <br /> BASEMENT: 1ST FLOOR: 14x-f-f_w7 100/..L rf odLErosionControl permit <br /> a ,3 _6, �t�L , TOTAL SQUARE FOOTAGE: + (slopes,disturbance, 7? / <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 3 �1 2-- App(/ , Review Location Survey <br /> ESTIMATED CONSTRUCTION and available options. / / <br /> —(Please round to nearest dollar) —10 —0. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes DNo ®Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes OVo ®Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ON() <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Dslo <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) ❑Yes I Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes EVo <br /> APPLICATION MUST BE SIGNED <br /> sas iiz(4/08) "'777 �r �� (Continue on Back) —to —► <br />