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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ,Ent /dPf^' t°� N2 ft, / /....�a ( s � El Zoning Status;CUP; <br /> OWNS ADDRESS (Num r,Street,City,State,Zip) Deed Restriction; CSM <br /> 2-2-t q /(4-0 7 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bog- 23-!fi 73 6,e 235 /b7- 5 co 7t 0��Wit' Iac e Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 6C-00 fl ,E^,P Me Pr. ❑ Site Plan including location <br /> AGENT ADDRESS/ CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ 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: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER 6(o /Z-21�-Q�('�f0-O ¢-1 DcPRtz- 2 .o y <br /> TOWNSHIP: /1 f V1r1 S i 1C.-✓i- '/4: 1/41/4. ❑ Driveway permits <br /> ADDRESS: 9 � � (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT I=1 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: � � <br /> 'cr-1(0‘t U M6/t-1-- pLyC)V\ ,kr n,0,-1) u <br /> . ❑This project is a new building or structure. U Pitted Use? <br /> This project is an addition/alteration to an existing building or structure. 0 <br /> SANITARY SERVICE: PERMIT NUMBER: D R ral ,;resS <br /> SEWER SEPTIC fn /# 0)": s - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) P <br /> S Ce(aI '''( } <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: try s �i�i% <br /> 4, TOTAL SQUARE FOOTAGE: 4, y ( lfet �rbancae, <br /> I>ng/a <br /> 2ND FLOOR: 3RD FLOOR: /'T`/ �ss <br /> o r. t on Survey <br /> ESTIMATED CONSTRUCTION COST: $ > �available hors " <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ a�t; 0 <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 g No ❑Don't know <br /> -3. Have you talked with the township about your project and are they in agreement? E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes VI No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 915.52) (leave blank if none) <br /> ' 6. Is a location survey required? (see reverse) EYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes J No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -P <br /> 545-112(4/08) <br />