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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE 2/t' <br /> OWNER NApiE l�' <br /> J e Tire td t .1-k ?Qci <br /> I Ci Zoning Status; CUP; ki <br /> OWNER ADDRESS (Numb4,Street,City State,Zip) <br /> d Deed Restriction; CSM <br /> ,7-1 , W P, f'" eU,JC. e viii WS `5358 variance # ) u��/ <br /> HOME PHONE •' LL PHONE E-MAIL ADD SS 7 <br /> t(14 -ggCi , -70 radienie(r• L0 afv1 ❑ Site Plan drawn to scale 73/ <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions . <br /> AGENT NAME COCTOR NAM ^""'"f— /Lf/ <br /> K I pp S (ic_S h Remvicotei,,t #. Site Pte. luding locati n <br /> AGENT ADDRESS CONTRAC I OR ADDRESS . . Septic Aj <br /> 503 LexI��-J 1 Dr'Ir� 4 <br /> (City.State,Zip) (City.State,Zip) Setbacks <br /> W au-ft a.Lee w I 53S`i 7 <br /> PHONE PHONE Site Plan approval from k it- <br /> 0 50 — L./.Lo 4 9 applicable township. <br /> E-MAIL ADDRESS E-MAI L ADDR ESS <br /> 11Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ■ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER 00-7 -273 -85c1D-0 A- 2 (4) Le •b5 frontage drawn to scale. <br /> TOWNS P: SECTION:Koxbur 21 '/4: Ni '/1/4: 5J kDrivew(aa •- its <br /> ADDRESS: (Stat ,��/A <br /> .11 . e_+ K.P SQu,k, Li WI- :__ Sanitary p-.... <br /> CSM: L.T SUBDIVISION BLOC / OT <br /> -7020 - <br /> (public ��' <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPT1 N: ,� <br /> +eXtr OW o Id p o rCh and rep I att. tkil Zoning District <br /> . ❑This project is a new building or structure. 0Permitted Use? kid i. 0 <br /> This project is an addition/alteration to an existing building or structure. � �'FP <br /> •'ice'R <br /> SANITARY SERVICE: PERMIT NUMBER: ural A.'._-- <br /> ❑SEWER SEPTIC (new/�ar <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I ❑ ,—- -• Inrxlplain/ <br /> AREA TO N :- F ..T SQUARE FOOT: Shoreland (attachment) <br /> (Outside 4,• slons I •'ng unfinished fire rages and above grade decks or porches \ <br /> BASEMEN ❑ Erosionc'on�ro�n?rmit BK.: 3 A3 ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR. 3RD FLOO-. 2,1,�,�—'�T Review Location Survey AI <br /> 4..._ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -+ and available options. <br /> (Please round to nearest dollar) $ 3 7, 000 . 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet f . ' a pond or I- e? 21Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 2{Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? BYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 51Yes ❑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) ❑Yes I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4 No <br /> 5 -_- too. v i76/ APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -+ <br /> 545-112(4/08) <br />