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71, 60 SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 3-On Y l'Qne e-ctav✓v, ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> t(6o(0 SQI'VILCII 6 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> '•i 83S-S�L3`1 I O� a1 HZ57 - '-Ha".4'` Q I C lD)cL c or✓1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> ATOWNSHIP: SECTION: // <br /> -row n d� Donn 32 kit.' 1/4: %%: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> I 10 to .5ar4‘..'it 1 Pd ❑ ,Q, S ___G),, _ <br /> CSM: LOT SUBDIVISION BLOCK/LOT (i. <br /> ., :.., 4 . , <br /> PROPOSED PROJECT INFORMATION `, !� j :':: " \ <br /> PROJECT DESCRIPTION: <br /> 8,,,\& b�c5.r S-$ora' jLe� �� t� <br /> 1 <br /> . 0 This project is a new building or structure. ❑ p t' <br /> U <br /> ❑This project is an addition/alteration to an existing building or structure. t <br /> SANITARY SERVICE: PERMIT NUMBER: alAddre" <br /> nSEWER SEPTIC ,n !- 4''V u ; <br /> 1L' Y <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) <br /> It - � '`::?•:41;,;:n1 a <br /> Shorel (.tcri� <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �C � - : <br /> j TOTAL SQUARE FOOTAGE: 4, :," „ ;� s " <br /> 2ND FLOOR: 3RD FLOOR: �w %4i <br /> �� Location t*Oy <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ .. _+ ♦ ♦ ♦ $ ©0 ' © � e <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 RI 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 14 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? ❑Yes N No <br /> APPLICAUS SIGNED <br /> (Continue on TION BacMk)T BE <br /> 545-112(4/08) <br />