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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE N ME r—/- <br /> I itD`?e." Ii e.� L LC ❑ Zoning Status;CUP; <br /> OWNER ADDRESS number,Street,City,State,Zip / Deed <br /> `-'t/ 67 Variance(# fiction; CSM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> / - 4 77/ 7/„ - // ( se. ;(...S ►ec:) /34-.)- -ids ^el ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> _TJa/e rL (ro-Nb', 6r k("-'L )M e j e r ( -i _ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A RESS of well/septic <br /> 7;?Le / *u.f` l-',,-L_ L <br /> (City,S e Zip) (City,State,Zip) ❑ Setbacks <br /> 0 a✓L c G( lx-G -- 3 S `") <br /> PHONE J'f C f/` fk e n PHONE ❑ Site Plan approval from <br /> Vol //a/ 7/.; - /13 / applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: Jti1' • CURRENT ZONING: ACREAGE: <br /> KJNPARCEL BER C/S�0 q-0Y,- 5a ' - _ a. frontage drawn to scale. <br /> UM <br /> TOWNSHIP: 3-S47p t-0 SECTIO : <br /> �r : 1 �i 2 I� ,gz,yl 1 : J 4 ' 1/o : c3 t.0 ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> �-- <br /> 73Ca / Cp��` ', . lif ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION 7'% <br /> Si`' t Review <br /> PROJECT DESCRIPTION: � �� � �, yid <br /> v If( e 73v i 1 I��° C3 � Dist t <br /> . This project is a new building or structure. , zz <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ,�,( PERMIT NUMBER: <br /> Q RU !dress <br /> f SEWER I�USEPTIC -s i ( 4, , .) <br /> Y � �_ - aala � ouc� �{ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t I 0 ainl <br /> AREA TO NEAREST SQUARE FOOT: SEE <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r <br /> d'i ■ 4, TOTAL SQUARE FOOTAGE: t v,,f t> yi , <br /> 2ND FLOOR: 3RD FLOOR: z °-� � <br /> /f/4 ivli ?Iav <br /> ESTIMATED CONSTRUCTION COST: <br /> - �, �latiCt(Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ yfSC'/ c�Da � ` , r y <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 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) r,-, Yes No ❑Don't know <br /> 7. Is this to correct a violation? 0 Yes No <br /> APPLICATION MUST BE SIGNED <br /> cJ <br /> 545-112(4/08) 7) CP 9 O <br /> (5.---- 2inu on Back) <br /> AV!/v L <br />