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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O <br /> ` \ <br /> i El Zoning Status; CUP; <br /> OWNER ADDRESS ( um Skeet, ity State,zip \ "� Deed Restriction; CSM <br /> .SQ\� \ % (-• V 3-3J) v\ Variance(# ) <br /> HOME PHONE CELL PHO E-MAIL ADDR \ <br /> ❑ Site 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 /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CU-y-ENT ZONING: ACREAGE: <br /> ElPARCEL n frontage drawn to scale. <br /> NUMBER *a. .1 O ∎. A Ate, \ 3q• <br /> TOWNS SECTION: <br /> 1/41‘� AAC /' /1/.S ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS:? ` �\ N\ c-3\.A <br /> J \�\j� �� ,► `� � �J ► ❑ Sanitary permits <br /> CSM: LOT \UBDIVI'i \ BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION '-',,ii;; -'STAFF REVIEW <br /> PROJECT DESCRIPTION: .., <br /> . ❑T .s project is a new building or structure. <br /> his project is an addition/alteration to an existing building or structure. y, <br /> SANITARY SERVICE: PERMIT NUMBER: � -- °" <br /> [1SEWER nSEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �#( <br /> \\ El Wett 9 ! s.•€t7 aint <br /> AREA TO NEAREST SQUARE FOOT: 4 I e4inL'I Bttacii ) N <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ! ' <br /> (s apes di t ,Y • r 1 TOTAL SQUARE FOOTAGE: 4, , 9 <br /> fiiing/a�ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> \/0. <br /> 0 Review iticxt ey <br /> ESTIMATED CONSTRUCTION COST: $Q and available 0 o <br /> (Please round to nearest dollar) ♦ •• ♦ ♦ ♦ ♦ �V�' O ,k,,, ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? _____ El No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes p No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank f none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION Bac )MUST BE SIGNED <br /> k ♦ -+ -♦ <br /> 545-112(4/08) <br />