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7i So <br /> j ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> Qav Lt/ Wa lk erg <br /> ❑ Zoning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 87 0 Tow„ <br /> 1.6 II Dr ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> 1001- 839—$9 '8 ci wck1ker 33 Q4o/ • C• rn ❑ Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> LI Site Plan drawn to scale <br /> and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> ❑ Site Plan including location <br /> PHONE PHONE <br /> of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL 081/)b.)-1)..70 I 18 83 '7 applicable township. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> SrJg1 Pen�l,r I�e 210 ' : TOgN '/4 : R 1/E ❑ Rural w/Addrng) <br /> ADDRESS: (new/existing) <br /> '-1 g)6, To IA, 14-c, II pry ❑ Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT `., <br /> "117 5 7 Z. 1 9 Pi 4,0 Z ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> Rep(axe a 11 d e c k ❑ Driveway permits <br /> ❑This project is a new building or structure. (state,county,town) <br /> This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER IX (public,private) <br /> SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1---1 ErosionControl permit <br /> BASEMENT: 1ST FLOOR: 4«k <br /> 'DsO X 2,0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: i 3RD FLOOR: 4©® /,r�6` <br /> `'-(LJ /l Cl Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) $ ��R , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes tif No Li Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes 2rNo ❑Don't know <br /> 3. Have you talked with the township about your project? NrYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes )$No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes 'No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(1/08) <br />