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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 /> D B KC{ -FLA 2 C c k. ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Numberrtrreet,City State,Zip) Deed Restriction; CSM <br /> b ` "4�`'�`(IK1' GIB( Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ,� <br /> ZI , i L/L? 7 Aou lesa_L/ e` e.&' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONY RACTOR INFORMATION and includes dimensions <br /> AGENT NAME 7 CONTRACTOR NAME <br /> Loll '5 'k�'l �/ Cf Ea r /3c,/ 14' 44 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> J 7-- 1/,}-1(E7 Pie-/ tiC <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> r 7> 04e Amp, y 5 - <br /> PHONE PHONE El Site Plan approval from <br /> 3 35 7F j 3 f applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> CAS t- to�t`der . g 4tiet,d,,r❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdnne.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT NIN : ACREAGE: <br /> ❑NUMBER RC ~c /-9000 0 ^0) 5 . ' frontage drawn to scale. <br /> TOWNSHIP: SECT O <br /> bV N 4 ,h. NE- ,//,/4. ❑ Driveway permits <br /> ADORES L <br /> 2.--° I Z (state, county,town) <br /> O #tot c��C t/�Cfoi4 % •. ��� `- P4 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> p4 IS')I%O14I d s-Tfi1 tocnA ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> is project is an addition/alteration to an existing building or stru ure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER PTIC �C. Ai a --L(9 t - (new/existing) <br /> HEIGHT IN FEET: p / NUMBER OF STORIES: (Not including basement)oo 11 c <br /> f�!P Oxi J ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMEN 3®'n 1STF OOR: ❑ ErosionControl permit <br /> / +i 5Z° 0.3 p 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: • J 3RD FLOOR: 'D filling/access) <br /> 5- '0 1358 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / O and available options. <br /> (Please round to nearest dollar) $ ! <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves Etrio ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes 2N-6 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#e01 L1 ) (leave blank If none) <br /> 6. Is a location survey required? (see reverse) [Yes No ❑Don't know <br /> 7. Is this to correct a violation? [Yes QIVo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />