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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> 'd O ERADDRESS (Number,Street,City, e,Zi ) �rnng Status; CUP; <br /> ' , zjt B _ t 937/7 sv jt �/ /Deed Restriction; CSM <br /> ,��?A u:�'rt (Variance(# ) <br /> HOME PHONE LL PHONE E-MAIL ADDRESS <br /> y- SAS d Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION rand includes dimensions <br /> AGE NAME CO TRACTOR NAME <br /> C_- \,Q/l � trZ y/' �. d kite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 331 E-11'' 51- <br /> (City,State,Zip) (City,State,Zip) Ilik Setbacks <br /> t.)// H/-� <br /> c// - t--e0 ce//S L?5-27 i <br /> PHONE PHONE ❑ S fe Plan royal from <br /> &SO_6(s 6 plic e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Moor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) elevation of property <br /> PARENT PARCEL NUMBER: CURR NT ZONING: ACREAG <br /> ❑ NUMBER v70�'ole 5-62// —� f frontage drawn to scale. <br /> TOWNSHIP: SECT C ``I <br /> '/ "/ 1/4: �J ° \ 1/41/4: riveway permits <br /> ADDRES : // tate,county,town) <br /> 7 C9a i Gj``l' Sanitary permits <br /> CSM: LOT SUBDIVISION /f BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> et, <br /> PROJECT DESCRIPTIpN� n ( �� 1..„ita <br /> its project is a new building or structure. t u <br /> ❑This project is an addition/alteration to an existing building or structure. 41 SANITARY SERVICE: PERMIT N ER: / • ' �' <br /> (SEWER SEPTIC •�UIJ o Sri ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) > 41/ _, '� = -_ <br /> 1 cr to•r : <br /> : e w -r <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 0El�Aion s ,;.t; ;,,. <br /> BASEMENT 1ST FLOOR:K 1 TOTAL SQUARE FOOTAGE: • x ' i s <br /> OO!!1F1'' J71 U! ♦ w� . .� <br /> 2ND FLOOR: 3RD FLOOR: (C / <br /> s S <br /> ESTIMATED CONSTRUCTION COST: /�f i et q ,";,:' ' <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 5����Qd <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lE'IQo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1 ss VaNNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Y s o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I ve 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 ei4'o <br /> (a , APPLICATION MUST BE SIGNED <br /> ^ (Continue on Back) ■ -0 <br /> 545-112(4/08) <br />