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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 8LAck6u1?*1i 1o17rt 7 Iv Kelly <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City.State Zip) Deed Restriction; CSM <br /> 20.743 Barber D(1 fO(.4 ltOV1, WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608.205-245/0 1.08-'772- 4332 j blackbuYW @ CoatptiaNtrx • CON1 Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JI4 t+ill ?Q lop IL Ttv11p1C SuiIdw'S LL-C. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2501 W 1311-1iilt. Italy It I13 2501 W 13044 n¢. +.1wy -* 113 <br /> (City State Zip) (City State.Zip) [Setbacks <br /> Mctdi50v1 WI 53713 Madidovl WI 53713 <br /> PHONE / PHONE ❑Site Plan approval from <br /> bog- ?29-3990 408- 72.1 - 3990 applicable township. <br /> E-MAILADDRES E-MAIL ADDRESS <br /> •tell•It ♦lW1p1QbuU45.CorN •+9ItIple. P tf ipIQlou/ld5•cov11 ErFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpd/accessdane.co.dane.wl.usl) � e <br /> levation of property <br /> PARCE NUMBER CURRENT ZONING ACREAGE p p <br /> ❑PARCEL 04�0�0611. 312' 301_o <br /> NUMBER Q_ 1 0.10 frontage drawn to scale. <br /> TOWNSHIP SECTION. <br /> P I Qa 5uvt1- 5pri vis —31 , %: %I A: ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> kill- 32 - !Anne ride Sr. 30 ace <br /> csM LOT SUBDIVISION BLOCK/LOT Ind Sanitary permits <br /> 32 G1'0140;4,9 E�1 , (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> 54161e Rim;ly 7,46f4Laici_ ❑ Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVIC PERMIT NUMBER ❑ Rural Address <br /> .EWER SEPTIC (new/existing) <br /> HEIGHT IN ET NUMBER OF STORIES (Not including basement) <br /> .Lf•G ' a ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR ❑ ErosionControl permit <br /> ZD$$ �dirs. 5- 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR:VQ aF{ 7, filling/access) <br /> <<O40 pecK poK AQ.A I$0' gy,9 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 'oo e w and available options. <br /> (Please round to nearest dollar) "♦ ♦ ♦ "'∎ '♦ ♦ $ V Irp <br /> _t)-itt. it , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Peso ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes • • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blank if none) <br /> 6. Is a location survey required? (see reverse) es EP ❑Don't know <br /> 7. Is this to correct a violation? es go <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ <br /> 545112(4/08) <br />