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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PR IDE <br /> OWNER NAME n <br /> DEI iiS e 3 ❑Zoning tus% UP; <br /> OWNER ADDRESS (Number,Street,City,State,pp) Deed Res i Ion; CSM <br /> aCD LEXINGTO(3 Si. 1cCaeuw) tai 53SSg Variance( ) <br /> HOME PHONE LL PHONE E-MAIL ADDRESS f <br /> ,1; .ST-9r150 ❑ Site Plan dr n scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes mensions <br /> AGENT NAME CONTRACTOR NAME <br /> ( ACV_ WOLF (pti1S"reVCTi6 Ki LIC ❑Site Plan cl Ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s p <br /> Off- COV T Lt&lt OZ., <br /> (City,State,Zip) (City,State,Zip) ❑Setb cks <br /> �bsoL.c UJ( c`I `7 3 <br /> PHONE 1PHONE ❑Site Plan .•• •t' I from <br /> `:7f gO ci - a 06 V applicable o , sh13. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> II RC tooLF C a .RvcT\oe_con n Floor plans scale <br /> PROPERTY/LOCATION INFORMATION (http ldlaccessdane.co.dane.wi.us/) n Elevation f roperty <br /> PARENT PARCEL NUMBER: /CURREN4OACRE AG❑NUMBER TZ ty !�(� •00 c frontage drawn • - <br /> TOWNSHIP: SECTION: t►� <br /> ,/4: ,/4,/4; ILI Driveway permits \vtV <br /> ADDRESS: (state, county,town) iceli` <br /> 5 + °C, <br /> ( ❑Sa a -r its <br /> CSM: LOT SUBDI SION BLOCK/LOT ',,n <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ei.1 t!'OeisS-nucrlon! s(r06L2_ IcA+N-t ILI ❑ Zoning riot <br /> . This project is a new building or structure. ❑ Permitte e? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ trral Address <br /> FTEWER tK L PTIC % CV 2 2 nclu I 3 ew xisting) <br /> HEIGHT IN FEET: NUMBER Or-STORIES: (Not inc basement) <br /> ❑ etland/Floodplain/ <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: % J „ 1ST FLOOR: ❑ (slopes, disturbance, <br /> permit <br /> 1`(./ � // y TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> 2ND FLOOR: �/ v 3RD FLOOR: ( filling/access) <br /> �� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ /MS I O and available options. <br /> (Please round to nearest dollar) I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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) Ekes ❑No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -* <br /> 545-112(4/08) <br />