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' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1,A,ve 4, 1.0?-1 N I E BST S ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Q Deed Restriction; CSM <br /> ZZ3 4. Muiker gf4iod�ve Paine Iwl 53690 Variance(# ) <br /> HOME PHONE CELL PHONE/ E-MAIL ADDRESS -./ <br /> 608-02 5 -'390 1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NANIE <br /> I <br /> 2q%4 Lq M11 A- t.0 bv/ dEjS /nC 'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2,61 c.a 4p DR-I 14 — -7 ✓ <br /> (City,Sta}e,Zip) (City,State,Zip) ❑ Setbacks <br /> so , pTvrit ,u► ) 53510 <br /> PHONE PHONE ��I like-Plan approval from <br /> 4 y <br /> I —6cc- 7-/93 1. (-6 GV- /Z-6/34 (f /ii applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> V>r164 Wibrt - - Via bade ,mil SAmv Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 14 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 13 PI 5'T'O- 1/4: 1/41/4: riveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> �� Y -e_ ,K-d- <br /> . nitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> S .. ,. s EsiAlE s <br /> PROPOSED PROJECT INFORMATION f:-STAFF RE IE <br /> PROJECT DESCRIPTION: ° <br /> i4GAV SMvJ(e -Vawltl1 1I00l,( ornng 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: €rral Ac e ress ar <br /> 520�j 7 � exi ng)� 4� <br /> ❑SEWER SEPTIC � � <br /> HEIGHT IN FEET: / / n V NUMBER OF STORIES: (Not including basement) <br /> �r etlart /F 6401at0� <br /> d ��:s <br /> 3 `:Shoreland (at mei t) .' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMEN 1 ST FLOOR: ( roS1QrlcQritrOl permit <br /> R I //7'7 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, ! <br /> filling/access) ` ,� <br /> 2ND FLOOR: 62. 3RD FLOOR:3 114 i*,',,-:eview'l ocatffT Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► ♦ ♦ /� and available o tons <br /> (Please round to nearest dollar) $ `7 i (A/ " ,, .. �,�, _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y's ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? OrYes ❑NA <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ErNo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blannkif none) <br /> 6. Is a location survey required? (see reverse) ❑Yes [V No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes (9 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ -+ <br /> 545-112(4/08) <br />