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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 /> V C'_C_,,A. an 0111 se c L.t C ❑ Zoning Status;CUP; <br /> OWNERADDRESS umber,Sires City, to Zip) i Deed Restriction;CSM <br /> > r il1 • ' i7 J YU Q_ 00 - I P6-k%60Y► 1,6E53-7/ Variance(#___---) <br /> H• E PHONE CELL PHONE E-MAIL ADDRESS <br /> pi I .,-, id ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AVE 1 E As A& V k' CONTRACTOR NAME ❑ Site Plan including location <br /> AGENTTAA/ppDRESS CONTRACTOR ADDRESS of well/septic i <br /> (City,state,np) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE <br /> ❑ Site Plan approval from <br /> applicable township: <br /> E-MAILADDRESS E-MAILADDRESS ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) ❑ Eleva60nofprope�Y <br /> ❑ PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: .1 frontage drawn to scale. <br /> PARCEL f <br /> Li :ER TOWNSHIP: \ SECTION: ❑ Driveway permits <br /> ,�� 4.1-.4- <br /> ,� 5Yl '/•: '//•: (state,county,town) <br /> Aoo6 8 a fi (^t, r ate" t- _ ❑ Sanitary permits <br /> CSM: J LOT f, SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: + <br /> • Ui s project is a new building or structure. - <br /> 0 This project Is an addition/alteration to an existing building or structure. <br /> SANITARY SER,VICE PERMIT NUMBER: <br /> MEWER ❑SEPTIC I 3 -,),0 /c °' <br /> HEIGHT IN FEET - NUMBER OF STORIES: (Not Including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: TOTAL SQUARE FOOTAGE <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST ♦ -+ ♦ ♦ ,♦ `,/��� �r CO <br /> (Please round to nearest dollar) J <br /> ,�� Don't know <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yee +��rye° •0 <br /> 2, Is there a wetland or floodplain on or near the property? ❑Y s [ 11 ❑ 't know <br /> 3. Have you talked with the township about your project and are they in agreement? es �0 N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ND o <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) <br /> ,es ❑Ng,-' (.3 Don't know <br /> 7. Is this to correct a violation? ❑Yes fo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) '♦ —0 —0 <br /> WM) <br />