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V I <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> Cie PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM K. trtitick \.-,. R�tnectt�- <br /> OWNER ADDRESS umber,Street,City, te,Zip) . ❑Zoning Status;CUP; <br /> `N Ka&v>d� , , I 5-3-}t Deed Restriction;CSM <br /> q a24 C`p �r. W Variance(# ) <br /> HOME PHONE 'CELL PHONE , ADDRESS <br /> 651-34r r <br /> 3-Vl3 rem, ••i S u-`n ft• ed t-t- ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> TbS Custom eohstivd6K ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR volIESS of well/septic <br /> \431 w orthecnn C.oc vi- <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> m ra&say.)VII 53703 <br /> PHONE PHONE ❑Site Plan approval from <br /> ( O«b_ 'a55l- `a\41--- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 10 i(1-9 COCA-CM CC7tlSkr ucrtidK,(AW ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: t ` CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL •�- �T 4- 33.5 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: 8z�6 1 0-1631004 SECTION: ` <br /> VV Yl v'� 10 1/o: t of N 1/e'/4: 1 -1 O E ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: NB (3ivev, �el- <br /> 2-1-b • <br /> To `.0'` J ❑Sanitary permits <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> YN 'ee Sic FVCJZ ❑ Zoning District <br /> . [ fhis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER E'TIC 1'-ao r a-- Ooo 12 (new/existing) <br /> HEIGHT IN FEET: `S i NUM "2_OF DRIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> aa Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and Above grade decks or porches) <br /> BASEME1NT. 13TTLOefl rl 0 S 2-j1 ❑ ErosionControl permit <br /> ti � \ A 2� ._6 6 0 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2M9•faGR:C 0~NC CA:et_ 4R13R:acw-v\i i0F(' +� r jF <br /> -3 24- 612— 0.72- ( 2 1 2..$ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ f] 1� O 00 and available options. <br /> (Please round to nearest dollar) a7 Vt <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [7lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es alo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? s a'Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑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 o ['Don't know <br /> 7. Is this to correct a violation? [lies o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />