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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME c e <br /> ;16 Kht w' 1Glad ' 6?Iie.,Wt ❑Zoning Status; CUP; <br /> OWNER <br /> ADDRESSS (Number,Street,City,State,Zip) <br /> aqua W G 60,4/ / Q a.d <br /> 640L tibic1 535eer Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL ADDIVSS <br /> :1 0-6.308 c,aoe-ep9S-8 348 n4 j ;0-4.44 42 -ea 1 k•e 'CO KA ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> b 1 t tC l c.< ( a taQ,,K ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR Ole y n ADDRESS of well/septic <br /> (City,State,Zip) (City, te,Zip) ❑Setbacks <br /> eu ltig-sm t 63669 <br /> PHONE PHONE r ❑Site Plan approval from <br /> (a 00-49g $3 .6 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> J ktte4,vi At i t°d k pC, (6,01 ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> W NUMBER 0(011 - '99 -Vele � W0 a,tr{ g frontage drawn to scale. <br /> TO HIP: I SECTI N: s� y 7 <br /> 1 fri t.-t+ LJ�T Ni� lj IA: !V to %IA: /V VV ❑Driveway permits <br /> ADDRESS: i (state,county,town) <br /> v9o9 elooH-ell i' / 6 1ttB-�, , c,J.t. 53581 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Dec it 1 - 3 ei Lf 4 a CC k►1-P - ti T Pi- LI Zoning District <br /> . ❑This project is a new building or structure. LI Permi ed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER IEPTIC (new/existing) <br /> HEIGHT IN FE T: / NUMBER OF STORIES: (Not induding basement) <br /> 1,34/4 - P - I If ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I—, ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: {� q 1 Q� <br /> v V LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ �0��0� 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? ❑Yes 1:1No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'io ❑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 F Io <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 Mio ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Cio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -i <br /> 545-112(4ro9) <br />