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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 /> DALE, Awb KA-2EN STENT1=14 <br /> [Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed 3012. SIATE 4WY 13'4 , on18Ri OFje, 'iv/ 53523 Varianceesnction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS (# ) <br /> ' a)/4z3-4"115 oe 22.o•-S(105- tsten•0 •rniti1•Cory! lErsite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> T 1 TIQ P14141.4 173 , L14_, Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 109 4EINES CT ,J <br /> (City,State,Zi p) (City,State,Zip) ErSetbacks a <br /> f <br /> _s <br /> ✓z- <br /> MOUNT 1-10Re , W/ 53572- <br /> PHONE PHONE Site Plan approval from <br /> c6 p$) 437-4442 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SuttcrT@ Wa2.L aid Hov►leg•Corn [Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> 0 PARCEL WO i2--01 t-$frpo-0 rT A-' (Ex) /1q• / frontage drawn to scale. <br /> NUMBER 1 J ''777 <br /> TOWNSHIP: SECTION: <br /> C4 -EJSTImw4 1-6-12 1/4: NW 1//: Na aDrivewaypermits <br /> ADDRESS: (state,county,town) <br /> 31 444 ST#.rr HWY 134 <br /> CSM: LOT SUBDIVISION BLOCK/LOT sanitary permits <br /> /2.5-1/ — _ (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Kew HOUSE Zoning District tir-t 61 <br /> . 23 This project is a new building or structure. ErPermitted Use? <br /> This project is an addition/alteration to an existing building or structure. , <br /> 1� ,�, <br /> SANITARY SERVICE: PERMIT NUMBER: Ca-Aural Address.574 IAA <br /> EWER nEPTIC /3-20 17 —00/S7 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22.•S— I 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) <br /> BASEMENT: 1ST FLOOR: EroSionControl permit <br /> 209 0 2706 4, TOTAL SQUARE FOOTAGE: 4, Slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> — ge 76 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -, -• ♦ 27� ZZS and available options. <br /> (Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes 'lo :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes o :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes �'10 <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) gfres EIVo :Don't know <br /> 7. Is this to correct a violation? :Yes i"Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • • -► -► <br /> 545-112(4/08) <br />