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SUPPLEMENT to Web-App # <br /> ZONING PER/1T APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> NQ. S <br /> u t in F. S #4 IZ- Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) , Deed Restriction; CSM <br /> q96 ea «y L417 e CYoS j in. s L'/ 5-35 p V riance(# <br /> )HO E PHONE CEL <br /> PHONE E-MAIL ADDRESS <br /> r -- , c41 7 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 6/� r-iyA 5�O- /6?J tr41 1C 5 "I&mj2 Site Plan including location <br /> AGENT ADDRESS ADDRESS of well/septic,epj <br /> Val �Lj 79?d 17 iisy G�„ <br /> (City,State,Zip) lAiu l a t p (City,State,Zip) 121/Setbacks <br /> PHONE PHONE S � i'�/ 3�� Site Plan approval from <br /> (S CA %33 � \ 7 q g- 2-5-q 7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 12/Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL 0 0'_131_.5 S�3 D S ^ J^ �� .�p frontage drawn to scale. <br /> NUMBER �T 1 �`/ <br /> TOWNSHIP: SECTION: <br /> -ev-r '/4: '/A: Driveway permits <br /> AD RESS: Y (state,county,town) <br /> ,,,�� 55 r <br /> CSM: 0 # 4 / •T `` ' SUBDIVISION i BLOCK/LOT C3 5>�$• Sanita •�.::mss <br /> (publi, ,private <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: I- <br /> S 1 ,e ry i4 ()pa,/I( Il Zoning District <br /> • This project is a new building or structure. Lod Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A•••�, <br /> EWER 'EPTIC (new/- V <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> (2., Wetland/Floodplain/ <br /> CA e-‘00 <br /> (attachment) <br /> AREA TO NEAREST SQUARE FOOT: C �0V <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit gyp <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 445-00 eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ /00 oat> <br /> nd available options. <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? [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? Yes 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 [RiNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ <br />