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om SUPPLEMENT to Web App # <br /> ZONING PERMIT APPLICATION www.countyofdane.c <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME y� <br /> /3"d d- I3 e u n•,a /7 o j o ki ck, oning Status;CUP; <br /> OWNER ADDRESS (Number,St ,City,State,Zip) Deed Restriction;CSM <br /> y-36 3 y 4 fo d 1? ?. C'�e y oar �3 S—7 - Variance # <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS ( ) <br /> boob t'1 s---/9 S3' 67�— 0/C d rry -o ye,..4.00. C o Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME //�� CONTRACTOR NAME <br /> N A A/A Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,zip) (City,State,Zip) etbacks <br /> PHONE PHONE Sol r <br /> applicable ite Plan approval townshva ip.f o <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co dane.wiusn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: A_� Fn a-Elevation of property <br /> ❑PARCEL DSZ./o 370-082-9Sv/ v �h�- 1��-/(� ) �QN /(ZQ��r�� g� ��, frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: /v �/.J p /, <br /> �v�/`� / : 1/4. . WA: Driveway permits A'.4 <br /> ADDRESS: (% (state,county,town) <br /> yid 3 CI-G,te /a .J 1 a' U` --e�3�� 4,t//- S,. s-)J <br /> CSM: LOT SUBDIVISION BLOCItAOT ❑Sanitary permits NA' <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION = Fk <br /> PROJECT DESCRIPTIO ///// �� <br /> A4, / /�- 11.424 d //��ti.l t (,�J 5u— ��i'l��� •`+ �� 1� FJ v Fes./ <br /> . This ro ect is a new buildin or structure. h °n' 7'� s � ` {' `' ' <br /> 8 <br /> P 1 9 Air= <br /> This project is an addition/alteration to an existing building zst?ruc ure. ¢, eft: <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> j004 e EWER Et EPTIC ,3 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,� <br /> 2G ' 7 " z— <br /> AREA TONEAREST SQUARE FOOT: ;. ,., �t t;, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � =h ` kn.' <br /> BASEMENT: 1ST FLOOR: ;;;:iit:',:,,:;: ::::::Z::,,,,::::;.:: �' <br /> 2 a x " mot' <br /> L/ 00 TOTAL SQUARE FOOTAGE: I . <br /> / ., <br /> ,J 3f 3RD FLOOR: g/ .2ND F OO 4 6l4 I a <br /> ESTIMATED CONSTRUCTION COST: �� a I <br /> (Please round to nearest dollar) �� ���,� x <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> Oyes o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes o r v)- C 6,41/4.1i i y F <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes �lo <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) QYes to DD know <br /> 7. Is this to correct a violation? <br /> Oyes 'JNo <br /> , ik4f) APPLICATION MUST BE SIGNED <br /> 545-112(4438 , (Continue on Back) _ _ _ <br />