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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> E r A..¢A-fr PB(jy n"-- <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) \ Deed Restriction; CSM <br /> 312 I Q ,4 I-e ter, C1 S'i n5 Si K ?( t 5-35.9 (� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> IP0I 8u 30693S" ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NT NAME I _, 1 CONTRACTOR NAME �p <br /> - ‘iv \P\,\ i�j'Yti vl DJ--4 ?1,∎ IS I s ❑Site Plan including location <br /> AGENT ADDRESS CONACTOR ADDRESS 0 of well/septic <br /> 1-314 6A-L-. P lAcfz <br /> (Ci�tY state,Zip,} (City,State,Zip) El Setbacks <br /> 5 5 -›- <br /> PHONE PHONE ❑Site Plan approval from <br /> (00 - q4-16 --j11o3 ) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑Floor plans to scale <br /> (Km 6 t 4 h G� , k.t�I' 1 s , c c7Y,r� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 06111 _ 18 '- 87-C) A-I I . 159' frontage drawn to scale. <br /> NUMBER o <br /> TOWNSHIP: SECTION: <br /> '13 r-i 1 8 .1/4: NE '/41/: !j No Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary •permits <br /> �. � fain � d5 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �- <br /> r-k-P 'A k + a ccQc l7 c0,—, it S CA-e,e (ev-f� Zoning District <br /> This project is a new building or structure. 1 ,,_,/ <br /> ❑ project 9 LtiJ'Pertnit#ed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ❑ <br /> , ,( PERMIT NUMBER: :Ru ,, " ` <br /> EWER I Y6EPTIC ( ''• ��" <br /> HEIGHT IN FEET: J NUMBER OF STORIES: (Not including basement)tt p}s Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) k. ErosionControl permit <br /> BASEMENT: 1ST FLOOR: r '/ rZJ8' + TOTAL SQUARE FOOTAGE: 4, tom`((Slopes,disturbance, <br /> fi <br /> 2ND FLOOR: 3RD FLOOR: ++ d,.—O/ �) <br /> �l7/1 Review Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ ♦ ♦ �D( DOO and available options. <br /> (Please round to nearest dollar) <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies Wlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Rio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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) Ekes ao ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ <br /> 545-112(4/08) <br />