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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 /> STC✓gd �� n/ �' ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4615" ,57-47- : .8/kkithy 73 J DF Fic=1-6 W/ Variance(# <br /> HOME PHONE CELL PHONE 648 E-MAIL ADDRESS <br /> 3`{-- )9 o S' ,s_10\11 s O vl .S PGS<e s aJeAr,.cam LiSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER EL ER °712-O'i-3-8o zo - o rL 12_ 8 /5.366 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> To w rJ o f D E2 Ft i t-1 1/$: 1A: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 41-1, 1s- S7-A T E H/Gl-Oh/ y 73, De-F 'r/EL. I.,/l . 355� <br /> 0 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> i zi-7 6(3 I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4 5L450m Poe.c-i f .4- 2.. )( cKS Zoning District <br /> riThis project is a new building or structure. Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 7-v s R 16 ft(4 t_ PERMIT NUMBER: Rural Address <br /> EWER [EPTICt/°y St (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1,1/EST 5 IDE <br /> 10 AND 2 j �/\Netland/Floodplain OF <br /> Shoreland (attachmentPROPERTY <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1,��l�4 ink disturbance,t permit NO <br /> 8),! et_tx r s� 4, TOTAL SQUARE FOOTAGE: 4 (slopes, <br /> l tJ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 866 0.0 <br /> Q'Review Location Survey NC <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ n and available options. <br /> a vp <br /> (Please round to nearest dollar) $ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? YES flYes j f o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? YES Lives EINo ErDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? .... E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes ❑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) Eyes ❑No ['Don't know <br /> 7. Is this to correct a violation? ['Yes ❑No <br /> DCPZP-2018-00463 EXPIRED WITHOUT 4 SEASON PORCH COMPLETED. <br /> THIS ZONING PERMIT ALLOWS WORK TO CONTINUE ON APPLICATION MUST BE SIGNED <br /> REV(01/19)4 SEASON PORCH PLUS TWO DECKS WITH STEPS. (Continue on Back) -o -O -0 <br />