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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME _ <br /> 6AVlb C OPT EKI KNaCKE I/ Z ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) r���1 1` w T D ed Restriction; CSM <br /> 9933 (Z1�4E R1� j 1 5.353 ri nce(# ) <br /> HOME P *NE <br /> CELL PHONE E-MAIL ADDRESS LL <br /> ,Vy y as-003-S 0124 1.p -oo IS e R1OC.c <br /> e. c I % COQ it Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an • cludes dimensions <br /> AGENT NAME CONTRACTOR NAME ,.'` <br /> x €- Cw /Tke..� eo �XN❑ Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> NI39d3 MAW HWY J <br /> (City.State,Zip) (City,State,Zip) Setbacks <br /> M O T'i RO E. , WI 53546 <br /> PHONE PHONE ❑S an royal from <br /> 126 g/551--- S I- a lic a township. <br /> E-MAILADDRESS E-1MAILADD S <br /> Qa4e-eike C014 -works. a or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.coouane.wi.us/) levation of property <br /> PARENT PARCE NUMBER: CURRENT ZONING ACREAGE: p p y <br /> ❑ c.NUMBER M 0911-1 'S '0 NO 1 2, 107- frontage drawn t cafe. <br /> TOWNSHIP: SECTI• • <br /> TON N OF-_ e.011A E OVE 0, , 1/4: M 10\. '/a1/a: N ❑ Drivew permits <br /> (stat ,county,to n) <br /> ADDRESS: 4/4/ . <br /> � E a El Sanita rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1:311 1 •ubl' , private) <br /> PROPOSED PROJECT INFORMATION �I TAFF REVIEW <br /> PROJECT DESCRIPTION: Res t a,eh1 I�- V I s1,e IOTA i'� ' w i^}� e4.- <br /> 6 e x 6 1*ali-vp coo r . Ail /roe al> ►r 'oning District <br /> . ®This project is a new building or structure. <br /> Permitted -_" <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: r PERMIT NUMBER: N ( ment) ❑ Rural ' •dreS <br /> f I (_N/A (new/e fisting <br /> EWER EPTIC ((HEIGHT IN FEET. NUMBER OF STORIES (Not including b s <br /> i a 1 One_ ❑ Wetland/Floo ain/ <br /> Shoreland attachmen <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) FM <br /> BASEMENT: 1ST FLOOR: 'J ErosionCOntrol rmit <br /> l4 C ,, TOTAL SQUARE FOOTAGE: l (slopes,dist ante, <br /> 2ND FLOOR: 3RD FLOOR: filling/acc S) <br /> I ❑ Review Location Survey <br /> t-R1C <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 3g5-0 i7.5- .5lrt, UX? and available options. <br /> (Please round to nearest dollar) 1950%OD OeYehitt i'iu <br /> 45rica 75 <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 RNo ❑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? ayes ❑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) [f res EINo ❑Don't know <br /> 7. Is this to correct a violation? Elves No <br /> ,,I3 n APPLICATION MUST BE SIGNED <br /> 54512(afoa) <br /> C) (Continue on Back) ♦ ♦ —► <br /> t <br />