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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 /> VIA i C it at / S C 41:wt y/n o Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6, 3 9-9 S c it I►wt 9e, Or till k r5 ks. 1( 5-3 SSA' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6C1-3-35-FC 9-' 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM E <br /> /Wile, / S L 1`...,5J <br /> y { G' 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> Paielee":Ile L44 537czf <br /> PHONE PHONE o Site Plan approval from <br /> 6 c - `Py q — 3(3'3 S applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> o Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: �^ CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> Egi PARCEL <br /> NUMBER <br /> O , 10('��6 4 So A-a (a) oc-- frontage drawn to scale. <br /> TOWNSHIP: t SECTION: , <br /> PA.e,&t IAA, Ors '/4: '/4'/4: o Driveway permits <br /> ADDRESS: (state, county,town) <br /> i(-3' -9 s c I 1,‘n,5 e,N /X. iM,.,rstt .(f (4,,r. - 6-3 5-5 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 10.1 ' O (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /� l <br /> -iO�A -b11( /� Pa(e s)1,24 )--G O 1 [1ctny etict tL ❑ Zoning District <br /> . igThis project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> EWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> zfi � Wetland/Floodplain! <br /> 3 Pik S CI <br /> (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> 3 3L1 ! ,, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 iiii ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ � � and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes g■o EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? oyes o EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ILINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®S'es ao <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) afes o<Vo ['Don't know <br /> 7. Is this to correct a violation? oyes Etio <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -* -► <br />