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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r <br /> • <br /> -T(K A M kin 14 ROE )(Zoning Status* CUP; (( 4 Z 11 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restri �;ISM I '� / <br /> c L SCOTT L , M CF&RL.k[D tot 53 X58 variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ) i I I <br /> 60S (08-6615 603 6g5'~75`4 -hvv.w•oc�eec€6J(1-( MnA"4.cmnn 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions ) <br /> AGENT NAME CONTRACTOR NAME h" le <br /> P t;.1.l40 r t, cL Si ing oca ion <br /> AGENT ADDRESS CONTRACTOR ADDRESS I V/A.,N A <br /> 026,4a Scott 1t,. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> K cf av-t ay.ck Lo t 53 <br /> PHONE PHONE ((Site Plan approval from / 4. <br /> (col.- 414 _' 33 , applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .4 no.-vv.&v. ait O. •w•ca k•cowl IX Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) � Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL rontage drawn to scale. <br /> NUMBER d(c(b-- �3-- (�{'" ( h <br /> TOWNSHIP: ,, r SECT! N: 01 / / <br /> TU M/V 1/4: .�(�l) 1/4'/4: W Driveway <br /> county,perm' <br /> ADDRESS: (state,county,,own <br /> a6`f a 5colt t-r∎ , Rc�ac-tow∎A, u3 t 5'3/58 P. . <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> . <br /> 5 a • R>II�S Q` pub li• -ji. <br /> PROPOSED PROJECT INFORMATION STAFF+REVIE <br /> PROJECT DESCRIPTION: <br /> 69`?C (�-f Yar4 5CLe honing District <br /> . 54 This project is a new building or structure. ;' Permitted Use? <br /> A- ‘ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: RnUeI aw)Ad. <br /> ° > <br /> .4 SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /0 I a ri T.ff ♦ <br /> Shoreland (attach t), <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> /0. 1, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 1° ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> ♦ ♦ ♦ ♦ ♦ ♦ <br /> (Please round to nearest dollar) $ ( 5OO <br /> 1. The property is within 300 feet of a stream .r 1000 feet om a pond • <br /> 0110 XYes 1ki No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near •e .1..•- ? ❑Yes VSNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Dg No <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 xi No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes INo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -+ -► <br />