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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 /> DEAN) P?Uk KA11)P ❑Zoning Status; CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1 126 PL I Z KO . Dec RriELO, k's. 5353/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60i— 2.21)r$01 0 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 3‘)STI1J SC-14M i TT ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3/b N. ArwD Ln/. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 'Oecitrit LP, WI, S 35 3/ <br /> PHONE PHONE <br /> /� ,'a VC- Site Plan approval from <br /> ti- S- S 2.7 G applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /tilt t7-&-diCSd YAHioo. coin ['Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ❑Elevation of property <br /> ❑PARCEL b36/ 0412.-329-90-0-0 v 1 i, ` j S' )e i frontage drawn to scale. <br /> NUMBER / � f <br /> TOWNSHIP' TION <br /> In eI)INA (5-$ -121/4: 5t.0 1/41A: S ❑Driveway permits <br /> ADDRESS' (state,county,town) <br /> )I ZG PLA Jr► Z RA). pik1-ik: t , cam, S 353/ <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> /6199 ( (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5/46D LK' N(({,3 i ❑ Zoning District <br /> ®This project is a new building or structure. <br /> LI Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> PEWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20 —`" f ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> I 0 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: IJ <br /> filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: L <br /> 1 <br /> (Please round to nearest dollar) ♦ ♦ $ L 000. 0-v and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes DNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ato ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? OYes DI`slo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes lalo <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 Olo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes J'lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --0, —, <br />