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. SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN AME., ,f /, 0-1 <br /> U r aild C v"Ti "IA/ i,!i Zoning Status; CUP; <br /> OWN da 5 (Number, re City,Stat/ ..) /`` Deed Restriction;CSM , a <br /> V Variance(# ) <br /> OM PHONE CELL PHONE r_ E-MAI DDR'S S. ,Q� <br /> fli M �� ,� , CV .1 i / �_ C ! G ,►:� Site Plan drawn to scale /�-� <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions 4 1 <br /> AGENT NAME CONTRACTOR NAME <br /> EiSit- ' -• .• ding location . �✓� <br /> AGENT ADDRESS CONTRACTOR ADDRESS 4.t VL3� ='• �/� <br /> Setb s 3 �� /f/J <br /> (City,State,Zip) (City,State,Zip) 00 <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/) ■ �f property <br /> PARENT (P�A�RCCEL�N�UMMBBER:a \, CU RENT Z NING: �X ACREAGE: frontage drawn to property <br /> scale. <br /> D %ER W i o V 19 So 40 .. .' \ 6 l I <br /> TOWN IP: l <br /> ( an l76 -1/4: M E- 1/41/4. S F LI-Driveway perm ts 1 <br /> _ (state,county, w <br /> ADDR SS: ` /� J� <br /> . s.A.�� , _•,a r. - . - On `�J� ' -JL [Sanitary permits <br /> CSM: LOT �^ �' BDIVISIO�_ BLOCK/LOT (public,) <br /> li <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJJ T-DESCRIPTION: / J <br /> / tcni -C7/e/l 4�/� 7L.- ( g(Zoning District A "`f , <br /> This project is a new building or structure. S jil (,Permitted Use? / 4 ✓. <br /> This project is an addition/alteration to an existing building or structure. 9c <br /> SANITARY SERVICE: PERMIT NUMBER: ti Rural A+'+ = S <br /> •EWER fitEPTIC (new/= < <br /> HEIGHT IN F ��i NUMBER OF STORIES: (Not/ including basement) <br /> \ ACWettand/Fioodplain/ f <br /> Shoretand (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) J�^E"onConUd permit ?- <br /> BASEMENT: 1ST FLOOR: J ( J <br /> 2 , +, TOTAL SQUARE FOOTAGE: + slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> "OReview Locafian Survey <br /> ESTIMATED CONSTRUCTION COST: ..4. ♦ $ and available options. 4 <br /> (Please round to nearest dollar) ♦ ♦ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? r ['Yes o ['Don't know w <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes lalo <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 o ['Don't know <br /> 7. Is this to correct a violation? ['Yes Vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -. -► <br /> 545112(4ro8) <br />