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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION . TO PROVIDE <br /> OWNER NAME t \ 1 <br /> ¢.fin S '� � n% v �", Zoning Status; CUP; <br /> JWNERADDRESS Number,Street,City,State,Zip) Deed Restriction; CSM <br /> `�jp1 - �wy N C �a�,¢,('' rove, Lot <br /> 535a-~( Variance(# SQ Z ) <br /> HOM PHONE CELL O Et-MAIL ADDRES <br /> CDC Sena CELL-lrP -3(9y� tltsNI‘n, 5ou.*p,tor(. <br /> ['Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA CONTRACTOR NAM' <br /> 00i) 0 Iav1 4000(5 U1 [ Sj#e Plan including location <br /> AGENT ADDR SS J CONTRACTOR A SS I of well/septic <br /> 0 ` t) V <br /> fity,State,Zip) (City,State,Zip <br /> 100 O k <br /> Ifr <br /> PHONE PHONE CI Site. a prova from <br /> ap ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Qf Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL el f ( 1—z 13--90°-Y 0 Z �j , -5 frontage drawn to scale. <br /> NUMBER (� <br /> TOWNSHIP: j( n SE 10 <br /> C? t4 ��- IOR .L 1/4:J.5 1/41/4: ❑ Drivew p its Mk <br /> ADDRESS: p ow (s ty,town) <br /> 37 ` �� �o4L <br /> El Sanitary per its I A 9- <br /> CSM: l LOT SUBDIVISION BLOCK/LOT <br /> (public,private <br /> '''/% i <br /> PROPOSED PROJECT INFORMATION tcy\ t/)c PROJECT DESCRIPTIO L ,0 p S AL u `' [ ;t c✓-k IG4411i tri€ <br /> . [I-This project is a new building or structure. Use? <br /> I=I This project is an addition/alteration to an existing building or structure. u <br /> 4rN <br /> SANITARY SERVICE: PER IT UM-�I P :;i) <br /> F1SEWER SEPTIC to <br /> _ r <br /> HEIGHT IN FEET: I NUMBS OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: 4 SiIt1 . <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) t t <br /> �D � - f 9.� <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, ' 4;04, . <br /> 2ND FLOOR: aFLOOR: 9)x S O <br /> ESTIMATED CONSTRUCTION COST: y <br /> 81fis"il�;�t3IE.'CS <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ '♦ � ic \';'''''K' <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 2 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 ❑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 15t No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -0 <br /> 545-112(4/08) <br />