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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.cIhM <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a/r///f c h1 7 /J✓S5 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Al 7 f ita8- c/ S7'c,h u/i 6'35 S 1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ;,4 — ;77-05D 3 kV' 24g-2?83 <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I 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,Stat , i ) ❑ Setbacks <br /> PHONE /- PHONE \ -❑ Site Plan approval from <br /> -- applicable township. <br /> E-MAIL ADDRESS V. 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 /> ❑ <br /> NUMBER f !/— 233-336' GG Gf 7�� frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .�uh�ii� r, 1/4. 1 xi: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ (pu i,t: !.�;,/_ s� <br /> PROPOSED PROJECT INFORMATION ', P-- �a,� �� <br /> ST 1�RE <br /> -4415 PROJECT DESCRIPTION: re " ° o , <br /> ?C- /-(-° <br /> Z i, <br /> . This project is a new building or structure. 7 . �1 _ <br /> This project is an addition/alteration to an existing building or structure. i - <br /> SANITARY SERVICE: PERMIT NUMBER: ®y° 5 <br /> SEWER SEPTIC <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) t 'y s <br /> c El ZV 1 \ f 8 •Q®® s 44 <br /> AREA TO NEAREST SQUARE FOOT: try ? <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or orches ° _ <br /> BASEMENT: 1ST FLOOR: ':12.!- <br /> NO ///0• ,, 4,TOTAL SQUARE FOOTAGE: • a'- ° . <br /> 2ND FLOOR: 3RD FLOOR: s <br /> 3 2,00 ® 0 0� F 6 .; .riy' w <br /> ESTIMATED CONSTRUCTION COST: �`: . <br /> � � —► —► 32.�oa - 1 €�s `� <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? El Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? in Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Eg No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#%O 7© ( ) (leave blank if none) 224/� <br /> 6. Is a location survey required? (see reverse) (u No ❑Don't know <br /> 7. Is this to correct a violation? s po <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -* <br /> 545-112(4/08) <br />