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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 /> A &3 P C L_v 6ti ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number Street ity,State,Zip) <br /> P'c� 0L. , 9(_� _Q Deed Restriction; CSM <br /> �`'l V )`�` Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> s46 ii• Z I Z3767._ A M SNP 4._TC3,O s'aMA,,- C'�'"t ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONT CTOR AME t_(,��Q5 A-/t 7cjdA3 <br /> A�/O�5 WE L_T6� .�'-D A..1T2U C i A„ ❑ Site Plan including location <br /> AGENT ADDRESS /1 CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> A,pPU 7 ( EE �z <br /> ❑ Site Plan approval from <br /> PHON Z/ Z �37tz PHt 558-eii6 applicable township. <br /> E-MAIL ADDRESS <br /> ' E-MAIL DDRESS <br /> �t (,-(E W /4A1 __,ecyi <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 /� Z ? (���/ frontage drawn to scale. <br /> NUMBER a��ceg-73> 5 — X <br /> TOW yIPA�: , SECTION: <br /> Tt�K( F(iiL] '/4: '/0'/4: 1=1 Driveway permits <br /> (state,county,town) <br /> ADDRE S , <br /> 3(04,p(rzk_U.S a . ❑ Sanitary permits <br /> C : LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ST <br /> PROJECT DESCRIP ION: ,/ <br /> District <br /> . This project is a new building or structure. � <br /> t?` t)! ' �`�,f <br /> This project is an addition/alteration to an existing building or structure. <br /> Rural resS <br /> SANITARY SERVICE: PERMIT NUMBER: j <br /> SEWER SEPTIC 44 /ate) <br /> HEIGHT IN FEET: (/ // NUMBER OF STORIES: (Not including basement) y <br /> (4 CQ €r: ,.ff i.,4 <br /> Shoreland a <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) © E ., ri%; s <br /> BASEMENT: 1ST FLOOR: , - 3s, <br /> 4, TOTAL SQUARE FOOTAGE: 4, '1,, Sdisttt {-11Ce. ;' <br /> o P} <br /> 2ND FLOOR: 3RD FLOOR: F W, <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ■ ♦ ♦ ♦ Q� 416� <br /> .-e'll'.-.:.:: s <br /> (Please round to nearest dollar) •p „ - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes o <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? ❑Yes ►, o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ <br /> 545-112(4/08) <br />