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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVI Z <br /> OWNER NAME i <br /> C IL 14 L 1 0 Zoning Status;CUP; I <br /> OWNER ADD SS (N mb street,city tate,ZIP)/ k G ,�t S 3 Sc c7 Reed Restriction;CSM / <br /> l �� V ` Y S h / Variance(# ) <br /> HO PHONE - AILAK SS /'`-� <br /> G CELL PHONE E C- - 61' " ' u s , co U Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension PL <br /> AGENT NAME CONTRACTOR NAME /� <br /> 'Site Plan including locatio S <br /> AGENT ADDRESS <br /> CONTRACTOR ADDRESS of well/septic <br /> t State,Zip) tg Setbacks /o% y / 0 / V <br /> (City,State,Zip) (City,Y. <br /> PHONE PHONE Site Plan approval from Al applicable township. p/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS �' <br /> !I Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ��� Elevation of property <br /> PARENT '''ARCELNUMBBER 6jL- CURRRENTZ I jG: ACREAGE::�7 frontage drawn to scale.0 NUMBER/V,/g a—V7) J�L1 �l ^ i / <br /> TOWNSHIP: - SECTION: , 1_I 1 <br /> N/ W D:• ay permits <br /> e vl /a: W /4/4: /� : county,town) <br /> ADDRESS: <br /> Se. e-- k Sa I' -ry permits <br /> csM: / 5 LOT ubli private) <br /> PROPOSED PROJECTINFORN A0 EW <br /> PROJECT DESCRIPTION: <br /> -2---0 ,,„ : :, -",-,i liSkal ' ' Z.- <br /> . <br /> 6,_ <br /> This project is . ew buildin '� $� '- .......d <br /> This project is an addition/a � <br /> SANITARY SERVICE: <br /> ■SEWER a SEP <br /> HEIGHT IN FEET: ) iil, 4,14111t,*,--mtl ‘: ] ; 3'z -Ai/ <br /> AR <br /> porches)(Outside dimensions including unfi �: a, <br /> BASEMENT: TAGE: 4, � aI s s. C , '' / <br /> 40 xa i <br /> 2ND FLOOR: <br /> - 4, <br /> ESTIMATED CONSTRUCTION COST: $ 0 0 IP 'F ' -, "°'s` -�'� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �3 V v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes O No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? fYes El No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ['Yes E No ❑Don't know <br /> 7. Is this to correct a violation? DYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 545-112(4/08) <br />