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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �,.-/� <br /> �C' ' ` � ��I`5(1)) Toning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 8i1(O DOM"fi (0> M7 1Ads uj l Variance(# ) <br /> r40ME PHONE CELL PHONE E-MAIL ADDRESS <br /> ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> KEN 4S t. msct c NS C-7`au Imo- a Plan including location <br /> AG NT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1EM2_ ►'vlc- 12MCLEN*" <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> �- Mt WO 4 c (.1-& 53"7 Lo Yvto x!Pr ti t, 53714, <br /> P ONE PHONE ['Site PI royal from <br /> W6-33'1-9/8/ 606-3 3Y-9/6/ ap ' le ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KOSLtI.�CA404-t-6* 7 (c6S4it_eptioIca4! .' 7 oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: t/ CURRENTZONING°I ACREAGE: Ele tion of property <br /> ['NUMBER <br /> 02 O/07o7 '32• -Vt w -0 Q ('� "` I 2.7'1 ntage drawn to scale. <br /> TOW SHIP: SECTION: <br /> Cros3 PIp,,,..,s 1/4: 1/41/4: El Drive its <br /> /ADDRESS: ( (Stat nty,town) <br /> V c � i{�vv1 ?sn <br /> P...(:::k <br /> CSM: n LOT SUBDIVISION BLOCK/LOT nitary permits <br /> (o S (publi . '. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Z 5 iv ( Ljir ci r-c c — /kp( t-Ti 01"i oning District <br /> . ❑This project is a new building or structure. fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A•• - s <br /> [)EWER IEPTIC (new/;xisting <br /> HEIGHT IN FEET: `t NUMBER OF STORIES: (Not including basement) la p <br /> - -1 , S O Z etiand/Flood fain/ <br /> orel.•• .ttach ent) <br /> AREA TO NEAREST SQUARE FOOT: 4111106. / <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '�k�/ <br /> BASEMENT: 1ST FLOOR: II Erosi•- ontr•• •ermit <br /> 1 blob 4 TOTAL SQUARE FOOTAGE: j (slopes • urbane, <br /> fill) • -ccess <br /> 2ND FLOOR: 3RD FLOOR: <br /> /N(ob 2.1 lb IV r-view bon Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ` and available o • ns. <br /> (Please round to nearest dollar) /` <br /> n@ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes DJo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes OW <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 Ell■o ['Don't know <br /> 7. Is this to correct a violation? ['Yes ['No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • —r —0 <br /> 545-112(4/08) <br />