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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ma rho 5zei cr-eS ©Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> I (0 koby n 014. rY)4-• 146 re b, L)Z 63 S 7 2- Variance(# /y y"!5 ) <br /> HOME PHONE CELL P NE E-MAIL ADDRESS <br /> _At: 07 137,r Me d- • $ '- -s2 4°,1 11'4 ;I "c°. ©Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SZeker e S ®Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 11b RDbyn Rcla <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> rn b H rth, Lur G35 7 3- <br /> PHONE PHONE fil Site Plan approval from <br /> (oOlS - ,4-6-A• y-o y applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -L e i t: re 5 . CxAt c ick Cc;) (Vtaj ,c Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ©Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL g <br /> NUMBER 0G30(0?5 I$3a Std 14" frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 131 ue Mo-unl ds SE '/4: lv e ,/,y4: Lo (Driveway permits <br /> ADDRESS: /�,� ,r� (state,county,town) <br /> 't 'L / ' i �� Rd' ' 21 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public;.private) <br /> . 1 `7/ `1!/,- <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ('m?Sh-ttalO n - ilea) home, u_)/ l kt_chcd 9 a ❑ Zoning District <br /> . ®This project is a new building or structure. <br /> ❑ Permitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT ❑ Rural Address <br /> {)EWER JEPTIC i3 ao r ? co ( 0 3 (new/existing) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> a 7 1 ❑ Wetland/Floodplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,--1 ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> , a Oa 3 5-0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 7_Co ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ a D and available options. <br /> (Please round to nearest dollar) �V �j ©00 '— <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes No ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes Ilo <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) DYes JNo ['Don't know <br /> 7. Is this to correct a violation? DYes INo <br /> / <br /> ` ' ' " APPLICATION MUST BE SIGNED -, <br /> 545-112(4/08) ` `b (Continue on Back) –► –► Iv' <br />