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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER CUSTOMER TO PROVIDE <br /> 13 rAO 1. Oit,-�2 <br /> OWNER ADDRESS ( s�Zip) // ❑Zoning Status;CUP; <br /> HOME PHONE 3 ©akUJc'o4 Dr 6.0 1� 6rovc_ k 535 11 Restriction;CSM <br /> CELL PHONE E-MAIL A� S (# ) <br /> 66P 235-902.9 &eV-5//a-70x,0 601/4(1.02, �ela r/car,h e_f- ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A " (0yJ� I S d d)i'Jz ❑Site Plan including location <br /> AGENT <br /> ,�ADDRESS !C CONTRACTOR ADDRESS of well/septic g <br /> vi0) Br 37L/3 co,/cwtc( 0s, <br /> >> (City,state.2.p) ❑Setbacks <br /> PHONE 4}'«3G Uft~ve t&Xt S352`( Lea ASSe[�:ea✓e-tti;� 535z- <br /> PHONE VA ❑Site Plan approval from <br /> 669°2 s "go 2-ri 600-Z-3S-0(--,-2-9 applicable township. <br /> E-MAL. I I-. SS E-MAIL ADDRFSS <br /> b '_P " 4.1" . e F 8041.42_ el .r ,n e ❑Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http:!accessdane.co.dane.wi.us!) <br /> El PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> NNUUMSER 0i9- 7/1 ° Levy - 53 78 Z A- + . 0 7 frontage drawn to scale. <br /> TOWNSHP: SECTION: <br /> Ctyii-cktt 6 b J e. to '/.: WA: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 7 -I 3 0Ni; /ieoc$ Or- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 4 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> Deck Li Zoning District . <br /> This project is a new building or structure. <br /> project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> ❑This Prot <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Adds FIEPTIC rIEWER (new/existing) <br /> HEIGHT IN EET ` NUMBER OF STORES: (Not inducting basement) <br /> bt4, Z. I ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT �� (attachment) <br /> (Outside dimensions induding unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: I—. ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: + (Slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 1.�p filling/access)- <br /> Lt R° ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ -�► ♦ -�► $ and available options. <br /> (Please round to nearest dollar) 7t Q�� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies [3lo [on't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o 't know <br /> 3. Have you talked with the township about your project and are they in agreement? []Yes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [f Yes ao <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 ligNo 0Don't know <br /> 7. Is this to correct a violation? 1__I'es <br /> APPLICATION MUST BE SIGNED <br /> 545-11(4/013) (Continue on Back) -► -► -► <br />