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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 /> KA2:r sre-e`7-irT ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> yccO AAl Eat LAAi kill y e_orilG67 621+" or ,S--3Q7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1 <br /> (/D$' Sr,- VZoZ ti1 -S"7(1-'77z�' K-Ce.,-. 4t :. . G-r,;eIs co. E-.«.r ld'SitePlan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> U e 1 j°r"e-Cr C. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4.1c4) A,P.1tL•14 W 44- <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> (--11'AI,f (,90J-f, tiJi 5-75-1-7 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (po - F y - Y.e a applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c (,,4 n k J Go ,t r ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.usn <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER 0 7 j I 03 (Apt F?t, /c - i i r 7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> (-t>./..r.;;‘,1 Cs 2-- u c 0 3 Y4: St= ,/%: S F ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9550 Ar4 le—/C.4../ £ 1' <br /> ❑ <br /> CSM LOT . SUBDIVISION BLOCK/LOT Sanitary permits <br /> I g (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRI N: ,/ <br /> �� 1+t I —D ` _ ' - 7 ❑ Zoning District rr <br /> 4'This project is a new building or structure. <br /> Permitted Uses <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI r Rural Address u ��f <br /> ❑SEWER ASEPTIC 5(newlexlstirlg) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' <br /> ' G '` C Wetiand/Fiopd plaint • ,; <br /> AREA TO NEAREST SQUARE FOOT: biand, (8ttgftrrtent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ErosionControl permit; <br /> 2 0 x Z j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fillinglacceis) <br /> LI LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --► ♦ ♦ ♦ - . ♦ $ 1100 , 00 acid available options. <br /> (Please round to nearest dollar) <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? ❑Yes ,No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ZNo <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) ❑Yes $No Li Don't know <br /> 7. Is this to correct a violation? ❑Yes , No <br /> 10 S CA 4_,� p _i)--iN s TT) <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/06) os L. gAdi 6 M I>Z--0 ( /ZT s nl91/S (Continue on Back) -► <br />