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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> r� r / ' <br /> I v °� " 0 V Et '� (l/ Zoning Status;CUP;Vii <br /> OWNERACARESS (NQmber,Street,City,State,Zip)22O VAL( c �3 T Died Restriction;w ( S,5Z - ction;CSM <br /> .. •' �% , — •_ as- Variance(# ) <br /> HOME ONE CELL PHONE E-MAIL ADDRESS <br /> 57 3---6z0 a Fk '*1 r-4 • .g-3 3itro . ky4a,C. T le Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 141 Vs/ US X-A-J C Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> 8 L K sol-R--tt U / <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE El SliPIan proval from <br /> 7‘7 - 2-7 z / Iplic e township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.clane.wi.usn <br /> PARENT PARC.EL U BER: CURRENT ZONIN : ARREA levation of property <br /> PARCEL a p a �QO " r ' frontage drawn to sca le. <br /> le.NM ER <br /> TOWNSHIP: SEC, I <br /> L l tc .f}�- (-t- _ %: IN) % : N E. D Iveway permits <br /> ADDRESS: tate,county,town) , b -30 <br /> e Z 0 9 / Kee 3a " ' K'ee �/ "a <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pOli private) S <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Ulla oning District <br /> ❑This project is a new building or structure. Permitted Use? <br /> This project is an addition/ teration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ �� a ddress- <br /> EWER EPTIC / 3 --0201(0 00010 ewb xisting) <br /> HEIGHT IN FEET: Is NUMBER OF STARIES: (Not including basement) '1� <br /> l V Wetland/FI plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attachment)(\, <br /> (Outside dimensions including unfinished area,attached g ages and above grade decks or porches) <br /> ❑ A ErosionCOntrol permit <br /> 1 Co' 1ST FLOOR: � ''`v ,` TOTAL SQUARE FOOTAGE: ,, ( pes,disturbance, lam <br /> BASEMENT: / <br /> 2ND FLOOR: VVV��� 3RD FLOOR: <br /> /ilin /access) r t <br /> rV 'v' <br /> (C)Ct Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 1 (�(� <br /> (Please round to nearest dollar) ♦ ♦ 'i "♦ ♦ —► Ol �! and availale options.At <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ./ QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes Jlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes W/ <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan f •ne) <br /> 6. Is a location survey required? (see reverse) DYes VV o QDon't know <br /> 7. Is this to correct a violation? es r o <br /> L� APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 4 �� (Continue on Back) —► —► —► <br />