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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE / <br /> D /T P .4�I El Zoning Status; CUP; <br /> OWNER ADDRESS (Num treet,City,Stat ip) Deed Restriction; CSM <br /> ,2 7y� .4 P r/c 7 e 1 v�•47/04 _ GtJ/ S"3589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADiMESS / <br /> ( 4003 "/4—3/ r--4n - c7rrni o dune, ce-r+ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION COF:TRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) El Setbacks <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/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURB NT ZONING: ACREAGE: <br /> ❑ PARCEL U 6//-3.:2/-0230 9--/ -,C-� Q , , frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ea .an ,0- <br /> p/-7 r 1/4: %IA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 027Y .4// e 6"4 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION 'ill, : ;'T�� t E <br /> PROJECT DESCRIPTION: / /�� / 0 f,a, <br /> Z-4c 4, 6.241 cjo F a t o ," <br /> • t S Lp t.c• <br /> ❑This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: - i , y: .i:',.° <br /> fSEWER (SEPTIC (new 9 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 7 M A.F / •/Fi �il <br /> x s 's attachment) <br /> AREA TO NEAREST SQUARE FOOT: X21 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: " E f'i a r ':,„,4,,:; t'' <br /> Pc? 4, TOTAL SQUARE FOOTAGE: , �p?eS,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> — <br /> 1/"2 S motion Survey <br /> ESTIMATED CONSTRUCTION COST: $ �00 and Sj opt ; <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 M No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes .0 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) El Yes ! No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes r0 No <br /> APPLICAUS BE SIGNED <br /> (Continue on TION BacMk)T —► <br /> 545-112(4/08) <br />