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' i ri <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER,INFORMATION, ':,,',-;,:.1.:'2.,, e, 1s t? 0;,1 y ,-_.-<'' t:-:-= ':': CUSTOMER TO PROVIDE <br /> OWNER NAME yy–� /� (, <br /> 6/etl✓1 c�MCP ∎/Ct1,tiCe Lon fleki Izoningstatus;cup; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> (� Deed Restriction;CSM <br /> /e�b0 PHONE G.Ake kegcrri $Ct RdAILADDRESS <br /> � `y�f� _�`t 5358'9 Variance(# ) <br /> • 7 " • a` 7 `� Site Plan drawn to scale <br /> AGENT INFORMATION ;•:, ; CONTRACTOR'INFORMATION ' '4,'-',22:::- and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Tip) (City,State,Zip) Eli i Setbacks <br /> PHONE PHONE • l‘ite Plan approval from <br /> ap licable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION+:;(http://accessdane.co dane.wi.usn oration of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rtY <br /> ❑ PARCEL 17/I, I 1 (Ex a frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: E A <br /> PIA,f..'0NCe i' 1/: A/W 1/4 : Ai E 3' irivewaypermits <br /> ADDRESS: X11 (state,county,town) <br /> a60 La Ke e ctemset Rd .5-1-0a,114.-4-1- kJ; 53 5?9 ,I <br /> CSM: L SUBDIVISICW BLOCK/LOT `ublic, peace) <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION, '.; :"A <br /> PROJECT DESCRIPTION: Sp.¢ . `TQ .". <br /> G-orQ 1° a8 x 3 fos T +- Bey 4. t-v eed . ' ig, a �- �. <br /> IX This project is a new building or structure. ,� s <br /> ❑This project is an addition/alteration to an existing building or structure. =} s <br /> SANITARY SERVICE: PERMIT NUMBER: �a'1 t �- .- <br /> 0 SEWER ❑SEPTIC k� -t�,; „ < <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) - y- _r � --• <br /> �'+mTp® $2 Y <br /> ig . '' <br /> •AREA TO NEAREST SQUARE FOOT: V '6 b <br /> (Outside dimensions in uding unfinished area,attached garages and above grade decks or porches) i . z <br /> i; 3 <br /> BASEMENT: 1ST FLOOR: �� �� r <br /> ?9 4, TOTAL SQUARE FOOTAGE: 4 '�c r fl ,,(t . , <br /> 2ND FLOOR: 3RD FLOOR: ' F a <br /> J e � 1a� _ <br /> - <br /> - <br /> ESTIMATED CONSTRUCTION COST: . . -- -► ► Q Q a DO i a f— �(Please round to nearest dollar) � ., Wi , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes , 'No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes ,I$(No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Ig1 Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ri 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) LI Yes ❑No (Don't know <br /> 7. Is this to correct a violation? ❑Yes cii No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -0. -+ <br />