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2r4 ql <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Seku11-2, L;0.nA Trust Ed RJea.►.l:e Se.14...tt2 oning Status; CUP; <br /> OWNER ADDRESS (NumbeY,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 2707 ' k4,01 Qocue l Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 604 6/7- 1143 bot 211- W.t 7 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME R4%,,cy t r <br /> Ra '&446<- aeC.Ker Nom Tvt prouev. a n't lit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2o$ mar:& kc.,..c 208 rbelar:a ga.ne <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Co ficiit 6ro e-, ta.J1 Sb52.7 Co{+a.te Cce oft) LAS t 53527 <br /> PHONE PHONE ite Plan approval from <br /> 6coa z/2- 383.1 l00% 2.12-315 34 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> be�i4r`ie„e ;rn•roue,.ge•�.4 te�Jer:ten..�et bey icier ko.v+e.nvpio0e„•e,,ifip Kr'�'�� Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levatlon of property <br /> ❑ PARCEL Q.S2 S frontage drawn to scale. <br /> NUMBER ti%JOb//-3 2.(- 2'232-3 R-2 <br /> TOWNSHIP: SECTION: <br /> PieO s&".1- SPr''"a s 32 Y4: ive, %IA: ova) nveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> .2.707 15414e.ra. Qoac( lei* -nitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> RA AcRCS <br /> Z 2 (public,private) <br /> PROPOSED PROJECT INFORMATION ,-TAF REIEW ; <br /> PROJECT DESCRIPTION: <br /> Screen pp rah o.clektges % oOtt ex:6 4•,..0 pa,f:o Zoning District <br /> . ❑This project is a new building or structure. ermitted Use? <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural AEI• 7 s, <br /> SEWER ❑SEPTIC (ne X13!IVY <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 15 / CI'Wetland/Floo¢f lai, <br /> AREA TO NEAREST SQUARE FOOT: Shorel rid (att - ,,,,-lie} <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑"Erosioppontrq permit <br /> BASEMENT: 1ST FLOOR: <br /> NO"C 30'le /8 lG 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturba ice, <br /> fillingfaccess) -� <br /> 2ND FLOOR: 3RD FLOOR: <br /> nlo.ne_ No Nt'c SSS n <br /> ❑�Review k.ocatibrI Survey- <br /> ESTIMATED CONSTRUCTION COST: $ and availabre a•t o <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CaYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? c„Yes ❑No 7,12C101\0 G <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 No ❑Don't know <br /> 7. Is this to correct a violation? CI Yes tfallo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -■. <br /> 545-112(4/08) <br />