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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Eric. Fes. ahsen Kc-..Agto ns& Ro pe_vt/eS L-l-Ck. <br /> OWNER ADDRESS (Number, reef,City,State Zip) r 1 1 1 i Al Zoning Status;CUP; <br /> 35 Co V n I i-u L AA o h4o r) W I ;3 Sg Deed Restriction;CSM <br /> A) �} / Variance(# ) <br /> HOME PHONE SELL PHONE E-MAIL AD ESS <br /> 60S -7 -0 14 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME I CONTRACTOR NAME• <br /> ?ca V i Ci d ki cei lL AV C Oe J none__ se, ec- e k <br /> gi Site Plan including location <br /> AGENT ADDRESS ) CONTRACTOR ADDRESS of well/septic <br /> 2r9 E���� � . <br /> (Ci ,jState,Zip), (City,State,Zip) 0 Setbacks <br /> (To VArtio n WI S3S8q <br /> PHONE PHONE Li Site Plan approval from <br /> 4:30 8 _ S-7-7 - 0 g(a applicable township. QA <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> i t VCkI r1 o 1 , Corp 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 6 Elevation of property <br /> Li PARCEL <br /> NUMBER 024000-262-0275°0 RE . .Z 1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> JD6 n cO 26 1/4: Qv) 1/1/: N E. Driveway permits <br /> (state,county,town) <br /> ADDRESS: (� II i <br /> 2-o92 Ba 1 e_✓ -DV-IULi S+o0 YJOf� LO I S3E87 Sanitary permits <br /> CSM: LOT SUBDI N i S BLOCK/LOT <br /> (public,private) <br /> 1.�i nCoI h P�I,k <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:�e vlkoo e_ e I S 11 a L,d q i d 3.. d e_ ■ •it SQ, <br /> W/ 5-a Ce, a�o v�) VI,,1 1 MO,\ i r)4 e ,o r Pds,t' l ci ej lin ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 2 2 ❑ 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 /> ErosionControl permit <br /> O 4 3 ,`TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR:T <br /> 664- - 15 07 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ •♦ ♦ $ I 0 0/ d 0 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 2Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No lig Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? CI Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) ,tilYes s o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 29 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • -► -► <br /> 545-112(4/09) <br />