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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION Www.countyofdane.com ►2 3 <br /> � % 3 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE / <br /> OWNER NAME <br /> , <br /> Pi <br /> f u Lk.-- Zoning Status; CUP;Pt)f 3 <br /> OWNER ADDRESS (Number,Street City,State,Zip) <br /> N L 1 P-LP /, ,�r(51 r Deed Variance Restriction; CSM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (o30 sci1 p4.3 aAA •r41.4 '.)44A-1- <br /> - 4 Ksite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AGENT ADDRESS CONTRACTOR DRE SWGf'�47S ing location <br /> fwell/septic <br /> CiVico Sch,e;?..e.i fzu4a. / �/ A-0 <br /> (City,State,Zip). (City,State,Zip) Setbacks OA �`� S <br /> PHONE PHONE '` wI 53 56 Z Site Plan approval from fi,f_ <br /> foar6_S53G-/601 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ehok. 17V ... :3 enro�e,bk1'I�.ai3a� o-. <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) El Elevation of property <br /> El UMPARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> NUMBER 05t2-051-7134"0 R- 1 o. 66 q cinth.9P drawn to scale. <br /> TOWNSHIP: SECTION: 1 <br /> �l l b i o 1 1 El Driveway per �� <br /> /4. /4/<. <br /> ADDRESS: sun town <br /> 115 adItCo ❑ ry <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanita <br /> 34 Otke. eie.rd.n�- 1.5 (publi ,pnvate) <br /> PROPOSED PROJECT INFORMATION STAFF REV 3 <br /> PROJECT DESCRIPTION: ,1011/ <br /> $/.1*e bk. d o a el ...ti. .'n,lc re,--'7.11) 1-74,,,,e_ d,: <br /> :Zoning Dlstnct;.Z <br /> iC This project is a new building or structure.. _ 6 -ermitted Use? `',-, <br /> ❑This project is an addition/alteratio : - existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: '.+ -'Address ' -?:=—'- <br /> lex <br /> EWER Q.EP IC ( e istin <br /> ... g) {._ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> '13 fee4- ,Wetland/Floodplaird <br /> Shoreland (attachment) �� <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> osionControl permit, fe <br /> 1 D 22 1 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, A; // <br /> filling/access) ,�/I <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5 2 7 2• Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. ; �/� <br /> (Please round to nearest dollar) $ 3 3 S,O Do. 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes taio ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes No DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Elves ONo <br /> 4. Has there been a.zoning permit issued for this property in the past 5 years? ['Yes RINo <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 t❑No DDon't know <br /> 7. Is this to correct a violation? [Yes Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(eros) <br />