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4--- •', Y', TlctC .t ' S 4ic C . :_r 20 ( <br /> `3 SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> #4, �. 4- RAE-<c 2, -r-t Li.,8-'m L ❑ of g Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 'teed Restriction; CSM <br /> 1-130 8 gr. , (ltfrzo K A-- t W! S X1.3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> •• 0 `6(6'1 (do-c76-0?3' ErSite Plan drawn to scalp <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> etC 7 13 0`k)b1M- toRJ', !I'i Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> _ 140 ?AI Lt g 7 , <br /> (City,State,Zip) (City,State,Ziip)�Al A / j �-�j a Setbacks <br /> Uj /z 'L 4-z 4,4 S1 `7 �, <br /> PHONE PHONE L9"Site Plan approval from <br /> 6 — ,--9 7 0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Wai W,a , 6 v;at ,ce>„t ©'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZONIING:// g <br /> ACREAGE: Elevation of property PARCEL❑ NUM ER Zr e. -34, v f�j -, -2 R14--( v. frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 7"bCJ" or V6to4e4 '/4: ¼¼: arbriveway permits <br /> ADDRESS: (state,county,town) <br /> r 7;a /365).e-4- EZv, U 6zp,.cA- , l.Jl 4—'0;13 ,� � <br /> LYSanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ""(0 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 46424 C"-WA` 1741.-E. 80/U.1)kiw4. fz �i ,t4-7)0e.a-)ei4 6' 2468 ,,a�, c�oning District <br /> . his project is a new building or structure. 1 'Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad• - <br /> ❑SEWER SEPTIC �. (new!, 'sting) <br /> HEIGHT IN FEET: U ER OF STORIES: (Not including basement) <br /> /to( f-��(B'' r I Irj i etland/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 /> Wifasi <br /> BASEMENT: 1ST FLOOR: OnControl permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, S open,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access)fi <br /> ESTIMATED CONSTRUCTION COST: 420/ ��, t"-eview Location Survey <br /> (Please round to nearest dollar) ♦ '∎ '♦ —0• -0. ♦ $ 3 -7 j o D D and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes >No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes NFVO ❑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 30 <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 Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />