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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NAME <br /> 11\L∎5IJ L. 1 Zo ing Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State, ip) ,p , �� D ed Restriction; CSM <br /> 1 �� `� � ' \ �� V�i1 t�� V riance(# ) <br /> HOME PHONE CELL PHONE t h,+ h E-MAIL ADDRESS <br /> 1(10 1 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME TRACTOR NAME — _ <br /> Ko& Rui , ■ ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic PliCcikuk 1.12- <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Li?& kZ r . -.3.5- 1-t <br /> PHONE PHONE ❑ le Pla proval from <br /> 0 <br /> 7 ' 0 L :ppli le township. <br /> E-MAILADDRESS - AIL ADDRESS <br /> 1 <br /> 1 , j — Cy & , , A■ NI F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBEmR:�t, RRENT NING: ACREAG p P y <br /> ❑PARCEL N� ' O L1 -1003- j 1 (- ( frontage drawn to s ale. <br /> NUMBER <br /> TOWNSHIP: t, SECTI j E___ ❑ Driveway mltS <br /> • <br /> P 6 1/4: _cE 1/4'/4: N (state, unt own) <br /> ADDRESS: l©ti } C V A ' In� 141\r (� ❑ <br /> CSM: �,/ LOT V SUBDIVISION `eJj\ BLOCK/LOT Sanita ermits <br /> (p bl' ,private) <br /> PROPOSED PROJECT INFORMATION f STAFF REVIEW <br /> PROJECT DESCRIPTION: 0 <br /> KA:MkNi_ p L� C' "f.1 ` - .b , t.�v3 1)f ■ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted -? <br /> This project is an addition/alteration to an existing building or structur . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural 'ddress <br /> EWER EPTIC (new/ex • <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ Wetland/FI dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore! (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I r--, ErosionCont ermit <br /> r� ,, TOTAL SQUARE FOOTAGE: ,,— (slopes, • urbance, <br /> ^ <br /> 2ND FLOOR: 3RD FLOOR: \V\`\i filling/ cess) <br /> / n <br /> CI G(c--) <br /> Review Location Surve V <br /> ESTIMATED CONSTRUCTION COST: -4. -1. —o. —o• $ ` © O O and available options. <br /> (Please round to nearest dollar) $ <br /> CO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes INNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑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) Des �No ❑Don't know <br /> ['Yes 7. Is this to correct a violation? Yes No <br /> G �(J 0 APPLICATION MUST BE SIGNED <br /> p� (Continue on Back) <br /> 545-112(4/08) <br />