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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWVER NAME (- A 1 <br /> NOEksoN VEItIMO�;i FARm NCitTH L*"d, PARTN ZSH►P [Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ,fin Deed Restriction; CSM <br /> 3? 51 0.yAIJ ROAD+ iLUE (MOON W `J 3 t i 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60$"101"39 5"3 vmite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME \ <br /> Aj.i ew E. AN�Jt�1SoIJ Gees . PART J€I, ( IV E) C tSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS C of well/septic 44 ifa, <br /> VA Aeov.c <br /> (City,State,Zip) (City,State,Zip) 121/Setbacks I)/A <br /> PHONE PHONE dSite Plan approval from <br /> (00S 1 V-3qS 3 applicable township. NuT <br /> E-MAIL ADDRESS E-MAIL ADDRESS REV d <br /> ['Floor plans to scale <br /> c/5 A A4c. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> [PARCEL 0(00/0706 -I 9 4-1geo-8 Ad (Ex) ' o goo frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. SECTION: VI V�l>MONT 19'7 .6 5- it 0r SDriveway permits <br /> ADDRESS: <br /> (state,countyoyvA) <br /> 1 J4 A 604 <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) N/A <br /> PROPOSED PROJECT INFORMATION STAFF=view <br /> PROJECT DESCRIPTION: <br /> Al SIB , Li Zoning District <br /> . RI This project is a Miw building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: it > PERMIT NUMBER: ❑ RuralAddress <br /> DEWER DE ICI v`" (new/existing) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not induding basement) <br /> i 3 / ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErOSiOfft✓ontrol permit <br /> 1ST FLOOR: <br /> N3a9 ,, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> �V <br /> filling/access) <br /> 2ND FLOOR: ` 3RD FLOOR: �� <br /> N A f A ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --► 7 and available options. <br /> (Please round to nearest dollar) O0O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes E No QDon'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 o <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 ENo [Don't know <br /> 7. Is this to correct a violation? [Yes No <br /> .1..;545- APPLICATION MUST BE SIGNED <br /> 112laios> \ (Continue on Back) —► —► <br />