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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEF NAME i j1 <br /> -Kb-e-c � Ak^ 1 ❑Zoning Status; C <br /> OWNER AADDRES (Number,Street,City,State,Zip) <br /> /040/(p�� �/W /ivy j �t I y , tar 13.5-1r Deed Restrict��� SM <br /> Variance(# /// ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> &CSB"2-/2-74o 0 or0534-/2.'2100 Y.,b01.1d0r$(49 e rt4408CV e,101 ❑S' Ian dr ••�,A.le <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includ , <br /> e. . :.- :�V• s <br /> AGENT NAME CONTRACTO NAME <br /> �.,b�,;118.-e.vs 4 I,Voc. 1, i c.c ❑Site Fir jcluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well,ptic <br /> fa014 Wy / f A � ,, <br /> (City,State,Zip) (Ci State,Zip) ❑Setbacks 2 N S Q <br /> 6tt .�tL e,.„14 ,4., S 3sir <br /> PHONE PHONE / ❑Site PIS p roval from <br /> W--7_4/L-z/a a applic/M nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> v_so tAld e 1 5, t,'tj64Yo.G0.-, ❑Floor plipito scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) ❑ Elevatio roperty <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: <br /> ❑PARCEL co .,. 7033,.9S°9r_ frontage yawn to scale. <br /> NUMBER Y�l �"r <br /> TOWNSHIP: SECTION: <br /> ,t-.- likrr4ti 1A: 1/. ❑ Drive permits <br /> ADDRESS: �1 (state, ounty,town) <br /> Jaoit, W I, ly 131&t ic- E0-.44-41 L41- 4 35 /C ❑S r ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p lic,private) <br /> 't- 1 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Nett) VI 00.64- L.- to• yew\l'iv.t``41 � L�w�❑ Zoni District <br /> This project is a new buildingor structure. �� Perm <br /> ' � p l ❑ Permitted se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU ER: <br /> U Rural Address <br /> EWER KEPTIC 13- 7-'44- 6©t 5 O (new/exi tl <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) <br /> I I 4-- 0 Wetlail loodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shortattachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosion ontrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 24 26.3 L//o .2 . l( 4TOTAL SQUARE FOOTAGE: 4, (slope , rbance, <br /> 2ND FLOOR: 3RD FLOOR. filling cess) <br /> 7/10-7. f® ❑ Re ie 'on Survey <br /> ESTIMATED CONSTRUCTION COST: Q and .0-a - options. <br /> —0. ♦ ♦ ♦ ♦ ♦ $ <br /> (Please round to nearest dollar) 3‘20/ 000 <br /> t Z b'eve <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies 1No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,flo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,c(es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? , Yes ❑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 No ['Don't know <br /> 7. Is this to correct a violation? Dies ale <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -* <br /> REV(01/19) <br /> 3 <br />