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s ss.. y ,i <br /> 4 * ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> KcIIy Loy 4.3-0.5tm Loy <br /> �� Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Li 39 1 51r-150 Way , fleForee t, NAM 5 353 2- Variance(# ) <br /> HOME PHONE J CELL PHONE E-MAIL ADDRESS <br /> 60%-`by2. 035L (Do%-Z.19-553q) kclly IOy1m1 6 fk yahoo.C,vrr■ >rSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ite Plan including location <br /> AGENT ADDRESS CONTRA TOR AD ESSofwell/septic <br /> (City,State,Zip) (City,Stat ) \ etbackS <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CU T Z ING: ACREAGE: P P y <br /> ❑ PARCEL 09107_031110 o . 25-z frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Vinci Sur 20 1/4: 5W 1/41/4: K E Drive .rmits <br /> ADDRESS: (stat ou ,town) <br /> `1391 5inojc) Way, L`evre5t, ' 52,53? ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT unit c,prerMteit)S <br /> Holland h'el+g- 1'tchl+fi0n Dr// <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 20' X Zo deck 9-Q r c --oning District <br /> . ❑This project is a new building or structure. \>i'.eermitted Use? <br /> a This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural =• s <br /> ❑SEWER ❑SEPTIC n'w/existin•) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ' and/ •odplain/ <br /> or-r: • (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: j j Erosio . • •I permit <br /> TOTAL SQUARE FOOTAGE: (slope di- rbance, /2)0 <br /> 2ND FLOOR: 3RD FLOOR: f I +�}� <br /> L4 �1�• <br /> eview Location ey J .- <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options � t <br /> (Please round to nearest dollar) 3 y.,._, <br /> c, <br /> /1e,.,lc.ftC <br /> ___ _,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes'lo ❑Don't Iknoto <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No Xi Don't know S:- Ms <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) ❑Yes I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes LEI No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -* -+ <br /> 545-112(4/08) <br />