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C " ° Ct-tb <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �y __ <br /> bor.u-.Ck 0-vv.‘ x LV-■ Cam' ill— ❑Zoning Status; UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re tri on;CSM <br /> 1 'Z2 1464n-cv.e r c \ 00— u.ro. E 1 L'1 '351-1-- Variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Loot-Ai-yN y (roil X335-a3'3iJ .b-i ‘4-4t' yn R.i i .001- ❑Site Plan dr wn�scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include ifnensions <br /> AGENT N CONTRACTOR NAME <br /> �w�[' ❑Site Plan in u g location <br /> AGENT ADDRESS , C TRACTOR ADDRESS of well/septi <br /> 1.12. I4-eurxy-e-e 1. ❑ ' <br /> (City,State,Zip) �/� (City,State,Zip) Set CkS <br /> PHONE 6-2\ ' > PHONE 3I� t �1 c53 1 ❑Site PI. .. r�' - rom <br /> 1 Li O `3�S - 53-SO appli ..I- ■ n•hip. <br /> E-MAIL ADDRESS ` E-MAIL ADDRESS <br /> crrkS, 4-1-1 @4m '°0 ❑Floor plai7s kale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevatlo o foperty <br /> PARENT PARCEL UMBER: CURRENT ONING: ACREAGE: <br /> ❑PARCEL U J l/ ok io_30- -SO b 1 r' 2 S frontage, awn to scale. <br /> NUMBER J• .7 <br /> TOWNSHIP: SECTION: <br /> '6.w k,e.- o 1I0piu'/4: q.� 'a'A: ❑Drive y mits <br /> (state, unty, n) <br /> ADDRESS: NY e`-2\ <br /> no adult'-,S5 o-°-Q Q . (32-10 q br' ❑Sanita rmits <br /> CSM: �� LOT suBDlvlsl0 BLOCK/LOT (public,p ivate)•t� • <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> • <br /> N.e%,,D horn-e_ 0 onSATIACAI CY\ ❑ Zoning i ct <br /> This project is a new building or structure. ❑ F'ermittetJse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R al Address <br /> MEWER IEPTIC /existing) <br /> HEIGHT IN FEET: ` NUMBER OF STORIES: (Not including basement) ✓J/ Y <br /> jirkil Z ❑ Wetlan, I... <br /> Shore:n. = n chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensionl including finished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion O +ermtt <br /> 2!"4.L� �� , TOTAL SQUARE FOOTAGE: , (slOpeS, -, <br /> 2ND FLOOR: f 3RD FL `� filling/a s <br /> N 2_tg v .•erb-r b ❑ Revie L j = rvey <br /> •::/ <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) '� ♦ ♦ ♦ ♦ $ is 35l o�U and a +L •:•tionS. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [) lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes CANo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ales ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Olo <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) Ekes No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes lNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -* -i <br />