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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER\` <br /> G v-lYVV1[;ev\ U vlA.0--":- Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> :3`-i (pD k\1-e,1-Qv- Nra Na1.4t_s� o l ` �`1� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> —C't %\ \ • :�-� , le Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> cl.vn e cap z a L)-� e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br />' (City,State,Zip) (City,State,Zip) Usgcacks <br /> PHONE PHONE ❑Sit I :•proval from <br /> a•. Icabl.township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) Elevation of property <br /> PARENT �P"ARR'CEL NUMB0,50.,--703,m ER: CURRENT ZONING: ACREAGE: <br /> NUMBER C:6 )a ` � � J/ 7 frontage drawn to scale. <br /> T WNSHII;: <br /> SEC . <br /> '/4: SE '/4'/4: riveway perm <br /> `�tc�� — (state, county ow. <br /> ADDRESS: <br /> I 0 94 4 E a ' - COv , •ermits (� <br /> CSM: LOT I UBDIVISION BLOCK/LOT (public,�• o I <br /> 3-5 'I:.`..a-9_ \ , '�� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIO : E_ . <br /> ekJ -Q_ ( k 04-- 0 v e. (`,6) a .I Zoning District <br /> . E5AThis project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: t) I Address <br /> EWER ,/.EPTIC 13-- aQ 15-0 0 i 33 �(xisting) <br /> • HEIGHT IN FEET `, NUMBER OF STORIES: (Not including basement) <br /> etla • - oodplain/ <br /> +. ' Sho - a • (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rOSi••C•• of permit <br /> BASEMENT: 1ST FLOOR: <br /> C t( , ,t,I 3/�� j, TOTAL SQUARE FOOTAGE: j (slop-:, isturbance. <br /> , filling/ ce- ) <br /> -2.1118-FtCi6R BPO F t`` <br /> Gavcr Q '1-15f)'1-15f)) . '"C 23, S (c r 1 eview Location Survey <br /> ESTIMATED CONSTRUCTION COST. $ and available optio <br /> -is(Please round to nearest dollar) --e. -+ •p :�� . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 01'es tANo QDon't k ow l <br /> 2. Is there a wetland or floodplain on or near the property? 01'es Do f Don't know vv <br /> 3. Have you talked with the township about your project and are they in agreement? , fres ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EJY TINo ,:s, ,,:;\kn..Z <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) es EiNo f]Don't know <br /> 7. Is this to correct a violation? QYes 14o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i <br /> 545-112(4/08) <br />