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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> R1 -/1A412D Eiidl y Aiki2GZ6-2 <br /> ❑ Zoning District <br /> OWNER ADDRESS (Number,Street,Cfty,State,Zip) <br /> 56,68 LD✓=G K (zD WAIt+N4/e6E' I'✓.i 53977 ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> 84.6— -"7/ <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> ssillzf As Age✓E 5 rK 144 Z020 vec4/6/475 <br /> AGENT ADDRESS CONTRACTOR ADD ESS ❑ Site Plan drawn to scale <br /> t23/1 /4a-6y 54'c'er and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> eR655 ,//1 /15 viz' 35 53 ❑ Site Plan including location <br /> PHONE PHONE of well/septic <br /> 46/- 3784 <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Li Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ NUMBER ogo9-919--8730-7 f4-/ Ex 0? applicable township. <br /> TOWNSHIP: SECTION: • <br /> ✓.zENNA— 0?1 1/4: 5E %/4I/4.Ayf ❑ Rural Address <br /> ADDRESS: (new/existing) <br /> 6-4,628 L.o✓.I-c/( /p W Amid E W-4- 53597 CI Floor plans to scale <br /> CSM: LOT SUBDIVISION / BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> . PROJECT DESCRIPTION: <br /> •QD1S Jp- emoo i-- re:, -r5T-i46 ,,e-.3-1/ /t0---7144 e Atte ❑ Driveway permits <br /> ❑This project is a new building or structure. (state,county,town) <br /> This project is an addition/alteration to an existing building or structure. <br /> Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: (public,private) <br /> ❑SEWER A SEPTIC 5 09862 <br /> $(p <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> go l4- SST 11 6 TD Rs7GC / Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: O <br /> / 09 �f //68 4, TOTAL SQUARE FOOTAGE: 4, (slopes,eS,disturbance, <br /> i A l filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> PG�DD ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ --► and available options. <br /> (Please round to nearest dollar) $ �/D�000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes .No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes f,No ❑Don't know <br /> 3. Have you talked with the township about your project? ;Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N.No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ■=4 No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes XINo <br /> (6-C*- v <br /> d O 5v'p , APPLICATION MUST BE SIGNED <br /> 545-112(voa) e Z �p (Continue on Back) ♦ —► -+ <br />