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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 /> &ENE WA-/HA/ <br /> Zo ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> / 35 3 ed Restriction;CSM <br /> CD O b I PD/Lri1-o-E gt7 70w/v a F r3vgiCE Variance(# I( O 9 5 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 244 _Z <br /> 23 • S'715-.a f e 1. - 0 LJ ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> KENNAN YDV A-lrE2 $tilt-DE/S []Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1 50 0 w "4.1 N s T_ <br /> (City,State,Zip) (City,State,Zip) aSetbacks <br /> .CA-61 ET 5 - SUN f'24-i it'E iI%v 1 5'3. 7'0 <br /> PHONE PHONE Site Plan approval from <br /> (Q .08 I-4-4 2-*I e / ' pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS Floor plans to scale <br /> Xe - &V 9' -, /hviJdi/s•cti <br /> PROPpRTY/LPCAflON INFQItMAtIQN (httpJ!ac sdane.co dane.wLs s/) �j Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ' ZONING' ACREAGE: <br /> UNUMBER01yK/e/AO U /9 / 3'8 7 1-I^ frontage drawn to scale. <br /> TOWNSHIP: !� - SECTI•• . <br /> • 4�U f 1 V�.. , 3 1/4: �'t.‘.) '/<'/4: s--1J Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> G e P Peir/f 6-E /2D 7D14/Iv OF 17 v`L.,C ,�,( <br /> CSM: LOT SUBDIVISION BLOCK/LOT L"J Sanitary permits <br /> I d q (public,private) <br /> PROPQ •∎'. ►1NRMIION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NE W S!Ne -L E F4/14/e,/ t-tom E ❑ Zoning Districtt,Z <br /> . gThis project is a new building or structure. N " Permitted Use? esea <br /> ['This project is an addition/alteration to an existing building or structure — 000 -�y l <br /> SANITARY SERVICE: PERMIT NUMBER: 3�a o u/Rural Address <br /> EWER IZEPTIC Y3 S 4 . " d 3 - 0'3-03 4—Qfew,r.�.o(new/4fi <br /> ' <br /> HEIGHT IN FEET: i 1 t NUMBER OF STOR IS: (Not including basement) r � <br /> ❑ Wetland/F000dplain/ 7 <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> iErosionControl permit <br /> I 0 5 2-'76 G c i 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: / y filling/access) <br /> tr6 Y ❑ Review Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ ♦ $ U` a Q o <br /> and available options. <br /> (Please round to nearest dollar) $ <br /> silk <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? mp-s \io []Don't know <br /> 2. Is there a wetland or floodplain on or near the property? r es ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? I Ves El. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? lYes Eio D.) ),rc_- <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 Dlo [✓]Don't know <br /> 1 <br /> 7. Is this to correct a violation? Yes o 1 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -+ <br /> 545-112(4/08) <br />