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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER IWAE . I <br /> Ken d g1is/t'i Sc_k Lei . []Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> CU 3 S tN s� /i'1 r�k,.'tiIJT S35 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> o?T'937-8 "8 .0$-576-76e) KeM �hW NI, e' bfl&t/.C°'"1 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 4 `. 'F-. :Site Plan including location <br /> AGENT ESS CONTRACTOR ADDRESS of well/septic <br /> ) <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> Air PHONE PHONE :Site Plan approval from <br /> 6 Cr-'-214- 7ct?'(1 3 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,H 5 htitif,N, 11 r eo :Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CU�RENTZONING: ACREA E: <br /> ❑Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> le. <br /> NUMBER O O c 3�I 0 _ �C,es <br /> TOWNSHIP: SECTION: <br /> S j 5-s r clat 1/4: '/.'/a: ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> 91 ca tKS g t MT Mare�b/ . <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> El <br /> permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> S h e d cons1'f m41-s o h - c'Wc 0 n J Sfr ,.w� 6-k;t, s-/et". ❑ Zoning District <br /> . ®This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) <br /> ( `, ❑ Wetland/Floodplain/ <br /> It'll T o+" ° ptt Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> Z G 1/6 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: y t,� <br /> #` ° ! ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 1 and available options. <br /> (Please round to nearest dollar) 1 J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ lo :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes o Jon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes OVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes JVo <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 10 ['Don't know <br /> 7. Is this to correct a violation? :Yes Vtio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />