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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App 0 <br /> PROPERTY OWNER INFORMATION ', FFICE USE ONLY <br /> OWNER NAME <br /> IV ICi 4-1 S ,b 0ks42'O U Z ning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / <br /> ///7 7 os'. &-t yy11�� Kiel, 'AN't) C <br /> /� /r� � ermitted Use? <br /> PHONE *516 1 _ X33 A E-MAILADDRESS <br /> �J Zoning Status;CUP; <br /> AGENT INFORMATION ' ' CONTRACTOR INFORMATION eed Restriction;CSM <br /> AGENT NAME CO TRACTOR NAME <br /> 7:ri,P1' ° 712`ve l� -n(. el/ KOOL-S ariance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 4 Ave 3 0'B 'o'00, l 14 e to Plan drawn to scale <br /> Y '��J nd includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> 11/1 146(3 0 A) Lc) r S' e Plan including location <br /> PHONE PHONE <br /> 6 08_ 1222 - 1 7 <br /> f well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS etbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL 038 O 7V j 112, I 1/✓"9 4—( /+�Cj applicable township. <br /> NUMBER <br /> TOWNSHIP: SECTION: , , 1 , l , , �+� <br /> (V!. flt30 L.c rc1it1 N yv /a/a: ❑ Rural :,• .s <br /> / �`' /4' (ne /existing) <br /> ADDRESS: <br /> -- 17 , I 0,2 c C 1 4;1cns-to c8ie <br /> CSM. LOT SUBDIVISION BLOCK/LOT <br /> 2-. D 3 ❑mat+ <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: / / `� �� / c <br /> �1�l'ffz�C)Ilk:� ({l�l)1/tt�r7r9 IL—" '�(` �-Dy Permits <br /> . This project is a new building or structure. �" (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. • 's <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> it public,private) <br /> SEWER J SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not inclu lgbasementj <br /> etland/Floodplain/ <br /> _— — horeland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached gara and above grade decks or porches) ErosionControl permit <br /> BASEMENT: 1STFLOO disturbance, <br /> 1 TOTAL SQUARE FOOTAGE: 1 (slopes, <br /> . filling/access <br /> 2ND FLOOR 3RD FLOOR: NC C <br /> v ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: f/� /� 00 <br /> (Please round to nearest dollar) -■ ♦ '0 ♦ - '-� $ 7'-°/U� ■"'""---- and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes V No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes TO No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes 14 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ID Yes No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> I <br /> sas-ttz(1/08) I I APPLICATION MUST BE SIGNED° s (Continue on Back) -♦ -i -► <br />