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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ar'a Nar�� Kerr 4. dZ9ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) laeed Restriction;CSM <br /> `43'4-- 14,vr+ `�o.c` , C�oL. . , W 1 5 3S a� 'ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> X08-- 1—(PC+a to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions . <br /> AGE,NT NAME CONTRACTOR NAME <br /> rgAtUrs.V•StkI c \Jc&ao.kk v2emoc:i€•%(1� Site Plan including location \ <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 10o1 Frr1..) 1-4 sI p kco cN�- N . c* _e-k- <br /> (City,State,Zip) e5 ! (City,State,Zip) L]Setbacks <br /> u fs.onw ./e. WI S ' ,N-") bv«..,.-\c1/4lG.F , k S35`n- S. a Plan a oval from <br /> PHONE PHONE Re"cl t=e rloe..,Do\c- ❑ <br /> 60i - g� Q -o,t a - 1/08- ``7loll2 --'1 �0 plic ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ` ` � kFz,nzA d ("°'��-%t�_��� loor plans to scale <br /> £'J ) X10 -) t' .cp f- -.el, .c • t,• <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.clfane.wi.usf) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZZONING: ACREAGE: Elevation io drawn p ryale. <br /> ®N PARCEL NUMBER <br /> o /OCIaB-x$2'855 lEX> I.�� <br /> TOWNSHIP: SECT O ' 1 t Driveway its <br /> t d /a: /a�/a: \4J ❑ y p <br /> �c1rve. (state,cpunty,town)' <br /> ADDRESS: / ' <br /> 3y�- K� SCI , C �.. S"- S a`� ❑ l Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, aivate) <br /> 2:30LA 1 <br /> 11;Ia 11 l~t4 PA:Willi 4 AI:I1 41-I„ENII1•l: . B 7-r ax . <br /> PROJECT DESCRIPTION: 11 s <br /> Sr V1 t'r-N cdt i 4cc 1 2 E ` <br /> 4 �I i -s�� . _( <br /> . ❑This project is a new building or structure. •t r -.-s- <br /> ®This project is an addition/alteration to an existing building or structure. F <br /> SANITARY SERVICE: I PERMIT NUMBER: 1 , f~$ 6 f - I' <br /> r)EWER IEPTIC I <br /> (r.I�e'r-�044' -, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) y <br /> AREA TO NEAREST SQUARE FOOT: .' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) = „,_ rt' °r; <br /> BASEMENT: 1ST FLOOR: ; <br /> TOTAL SQUARE FOOTAGE: j, .. i'+--t,� ... ' .°crl€c.-,. ,s� <br /> 2ND FLOOR: 3RD FLOOR: ` ti {/$i <br /> ESTIMATED CONSTRUCTION COST: 2 e Plor `� 1j ;(4C. ` <br /> (Please round to nearest dollar) -•► ♦ --► -�► -► -∎ $ I 0 : 300 E..{ .._. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0;∎ • ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes RI o Don't know <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 Do <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 (►��! o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ►4No <br /> o APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -■ -►► <br /> 545-172(8109) <br />