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LUNINti PERMIT APPLICATION WwW.countyofdane.com SUPPLEMENT to Webb--jApp # <br /> PROPERTY OWNER INFORMATION WEO - Z�3✓ <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Mh-ri f J 111 5 CHAFF N.E <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ( Zoning Status; CUP; <br /> 107 t'h K c PEEK,FI FL-p WI 5 353 I Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# CI 72.(i2 ) <br /> `I19 333 4188 M 5ct-IAFFt.JEK @ SHAIZEpMEp,r• <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes drawn a lion <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> P03(9 165 M li(LE I ti) M Alz.KL.Eim ('UI oFr5 I iuC 14 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 54-1 35 E, MI�i.�puKEC 5T of well/septic <br /> (City,State,Zip) (City,State,Zip) .Setbacks <br /> PHONE ANE5\/II/E Put 535'1(6' ik <br /> PHONE LI Site Plan approval from,008 7S Z Og '-j applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> HP RR7 RA eAv1-, - • <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: g Elevation of property <br /> ❑ UMBER 0 5i 2 32z 007D U AL 1 B. 1 Los frontage drawn to scale. <br /> TOWNSHIP: SEC�i I,ON: <br /> A Pile OW 14 1�p>t�� ✓Z- 1/4. W %4%4. N E Driveway permits <br /> ADDRESS: <br /> �C I T ( -CtzUNK. l It toF-ltn,'��( (state,county,town) <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT Sanitary permits <br /> i Z3l Z (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> KIEV.) 5 i U to LE rAM i i,7 TE51 9FIU G. Zoning District A- - 2-- <br /> - trAThis project is a new building or structure. n <br /> LI This project is an addition/alteration to an existing building or structure. Permitted Use? j'� <br /> SANITARY SERVICE: PERMIT NUMBER ✓1 _7 9 0 3 ❑ -,.. _ Address TO C (�❑SEWER SEPTIC ✓� 0-xisVng) J <br /> HEIGHT IN FEET: A 51 NUMBER I OF STORIES: (Not including basement) <br /> Wetland/Floodplain! /o <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attadlment '1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: XErosionControl permit _ <br /> Z5 3(P Z 5 3 j TOTAL SQUARE FOOTAGE: + ((((////���`(slopes,disturbance, , <br /> G'�foE. eOR 5 Toap filling/access) etis K <br /> �' 7 3 Co 2 C,00 7 eview Location Survey �J <br /> ESTIMATED CONSTRUCTION COST: ♦ -. -i ♦ -∎ —11. and available options. <br /> ��`1 <br /> (Please round to nearest dollar) Da 000 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CI Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ems- [No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#9 7Z(p) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) CI Yes 3No Cl Don't know <br /> 7. Is this to correct a violation? GI Yes No <br /> t ) APPLICATION MUST BE SIGNED <br /> 545-12 4/08 PRIUFt/)1 pE11MLT 07A-- 03 (Continue on Back) -► ♦ -► <br /> -Fitc sort f Ec.7.no et -OOf <br />