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4 Li <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> , <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> L awe.,11 H C t e.rill rAof\S LA G. IL L3.-C. ['Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Li g I I 1,47 i�A ke.ch �J M c 1....) , tvI 5 35`? Deed a is Restriction; CSM <br /> 3 Variance(# ) <br /> HOME PHONE y CELL PHONE E-MAIL ADDRESS <br /> (40 OS (V .. 41 s 1, ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> , t Uk4f it-x{1 ttn5 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> z,a, 6 v`, %-i-w/ 51 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> II\c rr�slur a , W 1 515 <br /> PHONE PHONE ❑Site Plan approval from <br /> akz - 7,05 - Is5? applicable township. <br /> E-P IL ADDRESS rt E-MAILADDRESS <br /> S{VW.IN(�\. V,k-IC " ❑ 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 /> ❑PARCEL 1 01010-o ci`l ,I"G C_ i p- I E� Is-' 37 Ac. frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: _ SECTIQN: <br /> TouN .C-- '�J `+ 1 `1 %: '� %1/4: 14 ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> a1 7 05 1-1-`)hw 1 51 ❑Sanitary permits <br /> CSM: LOT i SUBDIVISION 'BLOCK/LOT <br /> !J (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 140Of NA-ovt, ❑ Zoning District <br /> . This project is a new building or structure. <br /> N 0 <br /> Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: I PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 1I, I ❑ Wetland/F000dplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r—, ErosionControl permit <br /> ,` TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> `�G ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 00 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? JYes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes Ro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? lfres o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes EINo <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 alo QDon't know <br /> 7. Is this to correct a violation? ❑Yes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />