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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN AME ,/ <br /> �w V i GGUr,!�ti drvvLc€ -L Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Str giy4,State,Zip) Deed Restriction;CSM(� 3 6 J �� a��-2__ 6-3 5 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AD I:ESS ,� <br /> t , — 9,4 ?/ (t'y ?j�v'��l-3 CC(.�►�e �� A0 u/f' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATIiC:, and includes dimensions <br /> AGENT A E CONTR'A'"CR N/A-ME <br /> (�L(,L Y�'c�_ �l Kf' ❑ Site Plan including location <br /> AG NT A RESS CONTRACTOR ADDRESS of well/septic <br /> ,9a( 1/L�2 <br /> (City,State,Zi)) (City,State,Zi ) ,, ❑ Setbacks a j <br /> PHONE PHONE _ p ❑ Site Plan approval from <br /> �i — 3 1.i--/ 9'331 / - ljES 8' 5 7 6--(7 /4 applicable township. <br /> E-MAIL ADDRESS , E-MAIL ADDRESS <br /> /?�t�.tG r e end d f�'!'tu,�, (-prl t ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> ❑ PARCEL /t�CUG_ ER: /_ q—q IT / �/ 1 a frontage drawn to scale. <br /> NUMBER C/[ D `q 7 : ( O� <br /> TOW IP: SECTION: <br /> � � ,/; ,/,/: ❑ Driveway permits <br /> 4 4 4 <br /> ADDRESS: ,ql (state,county,town) <br /> / 6, 36e ° ' �� ❑ Sanitary m <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, privaperte)its <br /> PROPOSED PROJECT INFORMATION r "'I " <br /> PROJECT DESCRIPTION: % q <br /> I toning District <br /> his project is a new building or structure. k U� n" \ <br /> • a° • Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: © Rurair�. <br /> nSEWER SEPTIC <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement)�� �t :.+plait I Shamand attaAREA TO NEAREST SQUARE FOOT: iiii M(Outside dimensions including unfinished area attached garages and above grade decks or porches) a i Esic�Ci�trci BASEMENT: ST FLOOR: � 7,-ii,..)::!, ,, TOTAL SQUARE FOOTAGE: ,, E ! � <br /> !� Vr <br /> 2ND FLOOR: 3RD FLOC) : �� ;- <br /> R� e <br /> ESTIMATED CONSTRUCTION COST: $ ��}"� O.; i f �`� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ $ l� U ,y <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeslo El 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? Et. . ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# �—U (leave blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> Eyes ❑No Q Don't know <br /> 7. Is this to correct a violation? <br /> Eyes [.�1 o <br /> 0 APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />