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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVI E <br /> OWNER NAME <br /> ��„y tah Ar►c'tlrSc M Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Al D?j <br /> 914 A LJ. C lob er L. (+hae G-cam wl s 3 s Z 7 seed Restriction; CSM I <br /> --------_—__--- — Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (r•Og - 1 1 c.`--.-C-9/9 ,Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (3e:n Cc . 1:_ I.- r, - Il.twS - De 64 IGprNe..k Si P c ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/s <br /> Has . w. O4.eci sit L 3 30 'ZS �a -- <br /> (City,State,Zip) 1(City.State,Zip) Setbacks ' / r / �' S <br /> �c•+ti<^ G rG.LC f.e.,r -7i-2 7 --- -- 1 ©0 LB 4 xtv 'JO— <br /> PHONE PHONE Site Plan approval from (pyit. <br /> O G 3 - 06 2 O applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> COLA k1,_h() I.,,,0r,Sov/.,or.cl Cz-.M I% Floor plans to scale �// <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dene wi.us/) Elevation of roe /�G <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE: property rtY / <br /> El PARCEL p frontage drawn to scale. <br /> NUMBER 07/x.2 ZZ -5 - o -6 R -) J_j 09 <br /> TOWNSHIP SECTION: ) <br /> Cc.} �. G.x 2 %: i w ' '/a: w,) permit <br /> ADDRESS. 11/_______(4 (state,county, • <br /> Z 321 O • d � <br /> :d Sanitary is <br /> CSM LOT SUBDIVISION <br /> Z NS- pb <br /> PROPOSED PROJECT INFORMATION STAFF SEW <br /> PROJECT DESCRIPTIN: <br /> �eL., S. F--,i1 w/ ij a.se""_,,,A — — — --— — Zoning Dist ict , ��Z/ (� <br /> ' <br /> . This project is a new building or structure. ,i4 permitted Use? , X. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ,`, ` i)Address <br /> EWER PEPTIC /3— ZO/W -60'14 2 xtsttng) /l.-/ <br /> HEIGHT IN FEET. NUMBER OF STORIES ((Not including basement) , <br /> �� r ��yy��. <br /> -- - -L _. - - - ve er : 111-chment Y R- <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1 ST FLOOR: T— - —— — — Er6810ncQ * e <br /> t I + TOTAL SQUARE FOOTAGE: + (slopes,dlsttlrbance, / <br /> / 7 <br /> S tl .- _,S0 1 — — -1 filling/access) <br /> 2ND FLOOR: — 3RD FLOOR: � � <br /> — — j4 Review LoOtitlon So*:4 e <br /> ESTIMATED CONSTRUCTION COST: and avalla �Q /(- <br /> (Please round to nearest dollar) "� "� ♦ ♦ ♦ Z 3 /(�GU <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 12KO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes EK ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑ <br /> 24s No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 126;5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if ne) <br /> to6. Is a location survey required? (see reverse) [Yes ❑Don't know <br /> 7. Is this to correct a violation? . [Iles D <br /> `7 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (/�� 1 (Continue on Back) <br /> Il <br />