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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME ,f/r-Z <br /> J061 'F PoJc-wtecy '(,s4 RtZoning Status; CUP; pR‘ <br /> OWNER ADDRESS (Number,stfeet,City,state,Zip) Deed Restriction; CSM <br /> `/DI 6.,ilvh,- towt., s7beM/ .-,, wt 553535 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7IS-q3t-02 y9 45---t;-62Y1 1 Site Plan drawn to scale g.�� <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dime ns� gns &- c <br /> AGENT NAME CONTRACTOR NAME <br /> G' g(u4 Gam %, ac-4/171.9a 411 4 .��, =• luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ,,41 Y+ M■ <br /> 3� 7 ti� ,: sr Z 3 g7�7/` <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 0 <br /> ,54,4 k 4"� tJ'� Site Plan approval from 9,3 PHONE PHO applicable township. <br /> ld Cog-8`f3-C, 7� <br /> E-MAIL ADDRESS E-MAIL ADDRESS A ,c <br /> C Cow,tr. cons e oh/( 1400,c�, <br /> a Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property �'A 4© <br /> PARENT PARCEL NUMBER: CURRENT?ZONING: ACREAGE: �r rontage drawn to scale. <br /> PARCEL p -2 6 f0D <br /> NUMBER QSlo�S'�86sao (�fl / <br /> TOWNSHIP: SECTION: Driveway perm <br /> IQ�t(y„ol /5 1/4: E ��4��4' NW (state,county o n <br /> ADDRESS:q <br /> /c2I Ga/14. '4Gr 1.4,e_ zi Sanitary pew• its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi aa <br /> lvys(o <br /> PROPOSED PROJECT INFORMATION <br /> PR ECT DES 'IP •N: 0 '" <br /> r & >? (,flirt?`•" iv(;lieu) 1.�IIs eu4l��j eQrrss `�. <br /> This project is a new building or structure. � 45 <br /> ®This project is an addition/alteration to an existing building or structure. ; 1� <br /> '' , • 44; 71 <br /> SANITARY SERVICE: PERMIT NUMBER: ;# ��� ' �' '' <br /> SEWER SEPTIC <br /> HEIGHT IN FEET: ������ NUMBER OF STORIES: (No including basement) �, <br /> f l3 :''';'°`*-:a• <br /> i � ( r <br /> AREA TO NEAREST SQUARE FOOT: _ tw <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) e0, ," , o ' t . <br /> ASEM T: 1ST FLOOR: r � ; s • , " <br /> TOTAL SQUARE FOOTAGE: , ' re, r <br /> 2N F OR: 3RD FLOOR: 6O <br /> its <br /> ESTIMATED CONSTRUCTION COST: -'0 ,0-iii;;.y ° fi <br /> (Please round to nearest dollar) --► _ ♦ ♦ ♦ ♦ $ i(% CO va <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? ❑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? DYes ❑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 /> 0 3 3 S r� <br /> `� $ c U y � � APPLICATION MUST BE SIGNED <br /> I (Continue on Back) <br /> 545112(4/08) d 5. g y .4 <br />