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• <br /> SUPPLEMENT to Web•App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r <br /> t1r1>t�R& CE F E a Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,CRy,State,Zip) Deed Restriction;CSM <br /> 4553 . )fr c Q,CsgrJ Wf1`I , Ctwase c az,— t.'! 5 35 2r7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION i CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CFtKIb /Li-e4r Cols--r 911 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 31$b k.),44 6-/ RD- <br /> (City. setbacks <br /> (City.State,Zip) (CRY,Slate.ZIP) <br /> /"it 535 2'7 <br /> PHONE , ❑ Site Plan approval from <br /> 190-8) g77-13 (o6 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Owl s,(Pt is I I F.,coftisi-r venial 1114 C40-w, ► Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usi) <br /> PARENT PARC NUMBER: CURRENT ZONING: ACREAGE: a Elevation of property <br /> 1:3 PARCEL L OI g))-7//-034- 15/ --/ 116v R-- I s9 ( 2 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> -r,AGE VE 03 IA: 'fah: Driveway permits <br /> ADDRESS: <br /> (state,county,town)• <br /> 504rn6. AS V C Sanitary permits <br /> CSM: LOT , SUBDIVISION <br /> c-r °iKY.T <br /> To (public,private) <br /> ..l a 4S'RR2 <br /> PROPOSED PROJECT INFORMATION a . , <br /> PROJECT DESCRIPTION: <br /> A-pp rJ 'iv wt-r 5 1“.- 600 AD'>1 J A 0-e <br /> . ❑This project is a new building or structure. <br /> XThis project is an addition/alteration to an existing building or structure. i <br /> SANITARY SERVICE: PERMIT UMBER: x is <br /> ❑SEWER SEPTIC °5.3 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 1,440 1,49 GI +TOTAL SQUARE FOOTAGE: j <br /> PN}FteOR: JYoesP(0ov c i)SRB-FteOR: <br /> &A R) <br /> R Z E7L lST I.i G <br /> ( o -3IS -7 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► -► ♦ -� _ .. . Y <br /> (Please round to nearest dollar) Z'�`1C 1 �'�'� r v LL <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. Is there a wetland or floodplain on or near the property? LI Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑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? ❑Yes ❑No <br /> 31.72 Ex�S�'��c. mss% 3 g72- c1.(" <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 2-88 pe.130, A-Dp,� - �v4 AgCsia , : (Continue on Back) ■ -► <br /> -03 MIL_ 4 ci3 <br />