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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 /> K.J e t•.N- LL e- ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (. I54 0.,e1.., D/•u-. 0a.vt 4, W• 5-3 S-11 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> "LA-1/5-'S b►e.Q a-1...44b....,c....1 s4►.x.J...,. c,o.r, ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT rME CONTRACTOR NAME <br /> fl 4.4 L3 iterlSo4.1 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (,,Sc Ow I%•,. Di•∎"-- <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> tot,„.1, tom. S 3$? <br /> PHONE PHONE ❑Site Plan approval from <br /> *9 9-►/S'S applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER t xoS.-pt{3-7 u - - C - Z. (4. tp <br /> TOWNSHIP: SECTION: <br /> 542,1"5 C. I K `/ 1/4: S1..1 1/41/4: SW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4154 lj c^I D•,,,-� Oc„, ' 5332 <br /> 0 Sanitary permits <br /> CSM: LOT SUBDIVISION , <br /> S .•..�C•.Ii Comte go (public,private) <br /> 2 1 Gaa..,_•• t a. 44 Ye <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Alf/,3 ce.k5C ,-L d '-v 1 S'4. _,c L.,L)� j CI Zoning District <br /> . ❑This project is a new building or structure. Li Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER 1)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> a / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ <br /> Li permit <br /> ,` TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 466 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -4. ♦ ♦ $ ea. and available options. <br /> (Please round to nearest dollar) $ 4' ,oc 0, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es alo <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 alo ❑Don't know <br /> 7. Is this to correct a violation? Dies alo <br /> Z,(3 - f t APPLICATION MUST BE SIGNED <br /> t,t (Continue on Back) -i -4. -► <br /> 545-112(4/08) r r <br /> 236 x bo off,cE/sKor• <br />