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4 Ik <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> akar)\e)-\ 0,..)n(3. .bcO. x-c- -1S EiiSing Status; CUP; <br /> OWNER ADDRESS'(Number,Street,City,State,Zip) <br /> Ni <br /> .351/41--k SLYrit%I Deed Restriction; CSM <br /> di sa�1 , W l S3" 1 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (J206-33S-05(4)(A0 a Pla drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,"rka e Q__ ck J2 it(N . -r1a,V Ply p�m ll r\ q S PFan including location <br /> /4GENT ADDRESS J CONTRACTOR ADDRESS of well/septic <br /> 001 t-ran 1C.-- .14-. Si i e-e+ 1 ` ` t �-c.ii(. k. S -"- <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Iti ck-A- Rak--e--e . w 1 53S`-I-9 k.),-.—Dr.cio c2 , 1 5369 <br /> PHONE PHONE El Site approval from <br /> (gC -i3L-49 -51 SS L.008.-ot--19-Si SS ap ble township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Ilygio7plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) a Ion of property <br /> PARENT PARCEL NUMBER: C RENT ZONING: ACREAGE: <br /> ❑PARCEL CALA1.08`C�-�i0\_ '�-1 _/ 164/5. _ [, ✓✓✓✓ frontage drawn to scale. <br /> NUMBER �J <br /> TOWNSHIP: SECTION: <br /> Q,rK� ,/4: ,/4,/4: ❑ Dr w permits <br /> 10"'x, ° (stat county, town) <br /> ADDRESS: <br /> 3314 SoTNY1■11 Dr. , Nk.4 .1;5an. 1 53`9-163 <br /> CSM: LOT S.,r\b,�-S SUBDIVISION BLOCK/LOT El San . , permits <br /> � (pu• private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> I'`ex -inl1 coc a declr Sning District <br /> . EThis project is a new building or structure. 4mitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT E Ural Ad• <br /> EWER EPTIC (ne, `Sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I/ Wetla Fl plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Erosion',O► rOlpermlt <br /> BASEMENT. 11ST FLOOR: <br /> , / <br /> ! <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes, • sturbance, <br /> 2ND FLOOR: 3RD FLOOR: fillln• -cc •S) <br /> SSL s-,-C-jr Review ■'••.tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ --► ♦ �� and av-' de options. <br /> (Please round to nearest dollar) $ DD, <br /> WO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ENo ❑Don t know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes ❑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? ['Yes ❑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) Eves No ['Don't know <br /> 7. Is this to correct a violation? Eyes ENO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />