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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> KuAA'N, ,,,.ter' Zo ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ed Restriction; CSM <br /> at 5 cline Lc Ir u∎P.-%A L l 535 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C./c)b 8 726‹ (00$ (q' 3333 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 13;_42_, r a,,v.� ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> SA-z`t 51.0..,I::Xt C¢,ars.. c-t-t'2-o2 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> ft i-ck , L,1 53-2 i t <br /> PHONE PHONE El Sit Plan ap val from <br /> &016 t — UgS2 a licabl ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • 6-a 53 • m-a,.,,' 1. c e A's. loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> PARCEL / ro tage drawn to scale. <br /> NUMBER /Ok,i3O"3oa-8530-• A- l 1°0.5 <br /> TOWNSHIP: SE ON n <br /> (,�� • 1/4: N \(,) 1/4,/4. riveway permits <br /> (/ 'ADDRESS: (state, county,town) <br /> ( -#' (.� ( tpN. Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> i� � f <br /> (pub.c, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DES5 R/IPTION: \ii/V�w Avy»er % ❑L .coning District <br /> . <br /> his project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. `.. <br /> SANITARY SERVICE: PERMI MBE ❑=Cdd ress <br /> EWER REPTIC E 0! 7— O©a ?� isting) <br /> HEIGHT IN FEET: c ( NUMBER OF STORI1S: (Not including basement) <br /> ❑ Wetland/FI dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) (attac ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: r--, ErosionCo of permit <br /> 1 R b ( p 0(07 ( 4, TOTAL SQUARE FOOTAGE: 4, (slopes, . turbance, <br /> i' / j <br /> 2ND FLOOR: 3RD FLOOR: / !70\ CesS) <br /> �((�l/ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: '1 Q and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ dl,� O 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres glo ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres alo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? r'es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? y o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) blank if none) <br /> 6. Is a location survey required? (see reverse) ,, o ['Don't know <br /> 7. Is this to correct a violation? Efres Vo <br /> 1( 0 APPLICTATIO N MUST BE SIGNED <br /> (Continue on Back) -♦ <br /> 545-112(4/08) • <br />