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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFO <br /> RM ATION <br /> OWNER NAME,pe e e1"`��.1a i <br /> 'rJ ' fL <br /> OWNER ADDRESS (Number,Street,Ci ,State,Zip) 7. '�Z 1o2- <br /> OWNERADDRESS `'� <br /> HOME PHONE CELL PHONE E-M IL ADDRESS <br /> 22A-11°`} CAE <br /> ;21' <br /> AGENT INFORMATION CONTRACTOR INFORIYM\TION �I �� <br /> AGENT NAME CONTRACTOR NAME ,,f so <br /> M0 e/^ I I Rita Plan inrli irtinn Innatinn li <br /> AGENT ADDRESS CONTRACTOR D SS <br /> 413 _ <br /> (City,State,Zip) (Ci(y,State,Zip) r� ,,�, I �07.4 /R) 7 ( ' <br /> Wu' ",( ,P �/ <br /> PHONE PHONE �( (, 4 <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 14 . ci3CC <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) LI Elevation of property <br /> PARENT PARCEL UMBER: CURRENTZONI ACREAGE: p p y <br /> _D NUMBER o�p711--244-g?( .it Z `C ,i e frontage drawn to scale. <br /> TOWNSHIP: jjjj_//�� SECTI,O�('�: <br /> [arm Z`t 1/a: '/a1/4:_il 0 Driveway permits <br /> ADDRESS —11 (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> (public,private) <br /> 155 2ort- <br /> PROPOSED PROJECT INFORMATION 'STAFF REVIEW , <br /> PROJECT DESCRIPTION: . , <br /> o �( Zoning l IStriet <br /> . ❑This project is a new building or structure. <br /> ❑.Permtttetl Uae <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ FtUral d(lreSS <br /> III <br /> SEPTIC (new/existing) <br /> fft ; <br /> HEIGHT IN FEET: ' / NUMBER OF STORIES: (Not including basement) 3 <br /> E Wetland/Flood ain/ N <br /> Shoretand (att ,c tment)` <br /> AREA TO NEAREST SQUARE FOOT: , 5, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1 ST FLOOR: 0 ErosionGE3ntro permit,,` <br /> I �/� ,l TOTAL SQUARE FOOTAGE: j (slopes,disturb"cance�, <br /> I _1 filling/access) " g <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 0 Review Locatiot Survey <br /> ESTIMATED CONSTRUCTION COST: artd avadall[e optons, <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 42, 0 7%;, - z <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes id No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ►=1 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ea 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? DYes ►=1 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► - <br /> 545-112(4/08) <br />