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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 /> - I-GK k�r Zoning Status; CUP; , r <br /> OWNER AD ESS (Number,Street,City,State,Zip) Deed Restriction; CSM S b <br /> ��/ S t � �� /n�i ze ati�t1 INS- 535-60 Variance(# ) <br /> OME PHONE CELL PHONE E-MAILADDRESS <br /> 4 08,-7 b 7-2�r`7 , GOY y&3 '.Z��,B • Ia O S-� . td ', h e`� !� Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions _ <br /> AGENT NAME CONTRACTOR NAME <br /> R Si uding location4,- <br /> AGENTADDRESS CONTRACTOR ADDRESS of septic <br /> /d 0 /D /D <br /> (City,State,Zip) (City,State,Zip) IZ Setbacks <br /> PHONE PHONE Site Plan approval from V <br /> applicable township. G <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> K1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT P,A�/rR /L�Nr MBE 9,00 URRE ZONING: ACREAGE: p p y hi <br /> ❑ NUMBER tC/ V�f ��2 2 �, ��, frontage drawn to seal . <br /> -TOWNSHIP: SEC I <br /> /1„,‘._ A 0 1/4: iil , 1/: SC' Driv ay permits <br /> ADDRESS: county,town) <br /> Ce, <br /> CSM: LOT SUBDIVISION BLOCK/LOT ILA Sanitary permits <br /> G� / Z t,� �_ �_ (public, private) <br /> PROPO SPED PROJECT INFORMATION ST/I I REV`IIE 1/ <br /> PROJECT DESCRIPTION: I i / <br /> i e ,e S o x 2 / I 5-6 s r9 g = District <br /> . This project is a new building or structure. A rSj f `1 x Y <br /> / I �I trai • � �q <br /> ❑This project is an addition/alteration to an existing building or structure.w`D b' �/ 5-c <br /> SANITARY SERVICE: PERMIT NUMBER, ,R ° <br /> RSEWER FfEPTIC <br /> neWf <br /> HEIGHT IN FEET '��' NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: s,.ire* /� y <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ' '. <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: 4, (slopes,d�rb 1 <br /> 2 00o fi(ling/a s} - ,` <br /> 2ND FLOOR: 3RD FLOOR: 2 Q D r'� v <br /> v Raw Met <br /> ESTIMATED CONSTRUCTION COST: Q� / / P • B)�':i t e <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ / / (p Q w <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes I'No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ErYes ❑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 12/No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes NNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />