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ZONING PERMIT APPLICATION wwcountyofdane.com SUPPLEMENT to Web-App # <br /> w. <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> &regot y --X,ner <br /> / <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Wing Status;CUP; <br /> // 1080q Kin'T land 1?oad ate /1.443 W x 5'N/7 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE Variance(# <br /> E-MAIL ADDRESS ) <br /> 11410'0/ 9 jonejQ 11410'0/ avejone$i4C. Cow► a Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AGENT ADDRESS Sit n including location <br /> CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip backs <br /> PHONE PHONE <br /> ❑Site PI proval from <br /> E-MAILADDRESS 8p ble wnship. <br /> E-MAIL ADDRESS <br /> F r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ElPARENT PARC 'MRER CURRENT ZONING: ACREAGE: El tion of property <br /> PARCEL may_ p <br /> NUMBER *We �_„ awl.p Ril if /7 ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 8iis M0144 di ot6 1/,: NIA %I : 14g j NU) ❑Drivew ermits <br /> VLDRESS: <br /> _D (sta ,Co ty,town) <br /> /o Kin,- 4,4 Rood eke e ws C /7 Sanita ., rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu. ' ,p ivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> fF �/� <br /> Shea ' Clear/ IlA Id1419 0 x S n �e3 ice n' District <br /> • This project is a new building or structure. <br /> El This project is an addition/alteration to an existing building or structure. m1ed Use? <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> NiA ❑ Rural <br /> EWER DEPTIC (new - 4- i 'll' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ' <br /> i� . ❑ We . l..• . ,in/ <br /> AREA TO NEAREST SQUARE FOOT: S • _ attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ Eros • • tr0 permit <br /> Y1000 j TOTAL SQUARE FOOTAGE: + (slope_ c .y «_ <br /> 2ND FLOOR: 3RD FLOOR: fitiln a«_i '� <br /> ESTIMATED CONSTRUCTION COST: view <br /> • = •n Survey Co <br /> (Please round to nearest dollar) '♦ "i "► -• -* -► $ /00j 000 and available ;•nS. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? kno l/' ~ <br /> Dies Do ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> QYes o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? IN es LVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? e j es ONo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# /0(1%1 <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) QYes FINo QDon't know <br /> 7. Is this to correct a violation? <br /> Elves ZiIVo <br /> OL APPLICATION MUST BE SIGNED <br /> s545-112 taioel �� V (Continue on Back) ■ ..■ <br /> 4-0 i0 (Qvcl I'�}(r, +o <br /> Cs, KW <br />