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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> op EoR NAME <br /> o N ADDRESS a ber,Street,City,Stat ,zip) �� Zoning Status;CUP; <br /> k, 5 $, rok•F r, 1Peed Restriction; CSM /)9C7 <br /> Variance(# ) <br /> E HONE CELL PHONE E-MAIL ADDRESS <br /> 86,...s._ <br /> ,I l Site Plan drawn to scale 2 vy AGENT INFORMATION I CONTRACTOR INFORMATION and includes •_e:�;, ons CCC. <br /> AGENT NAME * TRACTOR NAME((�� <br /> ►ra.uv1 8 . 1 T 4.-nC . /Iil Site ' ; - •. luding loca on <br /> AGENT ADDRESS CONTRACTOR ••D RESS of • <br /> 2 y ,e ' • <br /> (City,State,Zip) ( Ot t.thp)L id �; �� / Setbacks <br /> PHONE <br /> PEP--v / �� Site Plan approval from ^, / <br /> EP-- 3 y 3-t C a applicable township. // <br /> E-MAIL ADDRESS E- LADDRESS <br /> f c k ,I e ti,s,,, 1 ee Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PA N MBE 'RENT NING: ACREAGE: ,W Elevation of property C�' <br /> ❑ PARCEL l y— —$�Q•� frontage drawn to scale. / <br /> NUMBER ( —/ // II <br /> TOWNSHIP: ,/ SECTIO➢I; a i / , p <br /> 1 Z�U[ ,�a:�/Ij/ •L�V/ ,�a,�a: ,/IV7 Driveway permit <br /> ADDRESS: (state,county, own) <br /> et.CSM: LOT SUBDIVISION BLOCK/LOT Sanitary p; ••its <br /> !_ (public,,---- (public, • <br /> PROPOSED PROJECT INFORMATION 3 F REVIEW <br /> PR JECT ESC TION: J <br /> 9 / t ( `` <br /> This project is a new building or structure. �/ e0C w ^ -� -'' <br /> This project is an addition/alteration tys�°' `gig building or struc rn to <br /> SANITARY SERVICE: Al.." PERMIT NUMBER: "•� <br /> ° t. r <br /> SEWER ['ASEPTIC / m <br /> HEIGHT IN IIEET: OF STORIES: (Not includin•ba •• �', 7 ° e(.) <br /> / / / <br /> • 'EATO NEAREST SQUARE F•ST: 0� �99,9(Outside dime -Ion g u Wished area, attached g. .•: . :bove grade decks or porches) <br /> i <br /> BASE T: 1ST FLOOR: <br /> a.,f • <br /> , xy p 0 a� TOTAL SQUARE FOOTAGE: , qq ( $ + > /iii6ess{J / / <br /> 2ND FLOOR: 3RD FLOOR: 1/ '!y5- 1 <br /> > :Ik lemon , /� <br /> ESTIMATED CONSTRUCTION COST: { qq � n c'vail9 8• €• / <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �J/ �� U t �� q,„ :.,.. <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑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 No ❑Don't know <br /> 7. Is this to correct a violation? NJ Yes g No I 1"1 4- J i APPLICATION MUST BE SIGNED <br /> f/''//� r (Continue on Back) ♦ -♦ <br /> 545-112(4/08) /� e V ' t <br />