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ZONING PERMIT APPLICATION www.countyofdane.co SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> //// ..ems- i <br /> �;H v-- 1 .0.4 v k.,Cli V 0❑Zoning Sta s; C <br /> ON ER ADDRESS (Number,Street,City,State,Zip) Deed Restr ti ; CSM <br /> r- <br /> G6 7 /—e-/—e-.1 e 61-- Variance(# ) <br /> HOME PHONE CE L PHONE E-MAIL ADDRESS <br /> ✓! -r 32 j2.a . "I ,i>7 , Ge,u, ❑Site Plan a n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> —3-63S 17 t tlLcte L o 6574 ,�o h!y/le ID Site Plap incl Ing location <br /> AGENT ADDRE S <br /> CONMIACTOR ADDRESS of well/se t. <br /> 5 e y 76O2_ 'I.`015`ci'C P e <br /> (City,State,Zip) (City State,Zip) ❑Set 14 ve x w t <br /> PHONE PHONE ❑Site Pla •jkv. from <br /> C 27c — X76 L/ applic •. n ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Floo plaVscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of p perty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ❑ Driv- ■ mits <br /> 1�a: 1/a1h: i <br /> ADDRESS: r (sta Fi�, • ,town) <br /> 3'66 7 (-4d y Thl4 G - (4—e a- m-7- '99'3 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ,, fL Du 2 <br /> (public, P ) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Re,14- deck d-- (> ( ( / b x 16 5 CcBa(it(cyo,vl. ❑Zoning trict <br /> . ['This project is a new building or structure. ❑ Permitter Use?' <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad• .s <br /> FIEWER EPTIC (new/exl <br /> HEIGHT IN FEET: V- NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/ I. t,,f t,ain/ <br /> Z r Shorela i! ``•:• meet) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionCo •IX t <br /> 1 <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes 1 ;,= Ce, <br /> 2ND FLOOR: 3RD FLOOR: filling/aI,r' s <br /> ❑ Review 1_4'4,-;, ,n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q� �� J and a '-•1:t.:I ens. <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? Dies nNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes `,F o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Lives ,lo <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) Elves Er o ['Don't know <br /> 7. Is this to correct a violation? [Yes `Ig 10 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />