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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> b 1 '-- �"Ok. S0� G.-b r/ <br /> ekr 1-1-C ( - - s &A-6-) ❑ Zoning Status; CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDREESS <br /> 60P> 7i2 /6 9 3 3 L0 b ? �'^a� -o'^'t ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME / t Sfr P ONTRACTOR NAME <br /> S.0)144 A.to I-0'i kijdfl"t-S UyC ❑ Site Plan including location <br /> AGENT ADDRESS esd CONTRACTOR ADDRESS of well/septic <br /> 6905 Se7 a i <br /> (City State, ip) (City,State,Zip) ❑ Setbacks <br /> ci'd �S�I w i 53.7i 1 <br /> • ONE PHONE ❑ Site Plan approval from <br /> 6oS) 2SS- 399 ( applicable township. <br /> -MAIL ADDRESS r E-MAIL ADDRESS <br /> j Po t c @ , )/.LQ,� 1=1 Floor plans to scale <br /> ,vta PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> [=I PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/: 1/1/4; ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION �� it <br /> ROJECT DESCRIPTIO r%; <br /> . ❑This project is a new building or structure. Q Permitted Use's <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: El Ruratmgress Rural <br /> f SEWER (SEPTIC n,1441exiStin9) <br /> i <br /> HEIGHT IN FEET: NUMBER OF STORIES: (iyoncluding basement) <br /> Shorel (a y <br /> AREA TO NEAREST SQUARE FOOT: „,„„ , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ws : f <br /> BASEMENT: 1ST FLOOR: ” � � <br /> TOTAL SQUARE FOOTAGE: + �'� i`� } 1 s� <br /> 2ND FLOOR: 3RD FLOOR: <br /> -3i <br /> C3 lie ,,., <br /> ESTIMATED CONSTRUCTION COST: �r erl •3•i a <br /> (Please round to nearest dollar) <br /> ♦ ♦ ♦ ♦ ♦ ♦ ��� � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes •,L4 k o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1 0'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? /5'Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ea es <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) Eyes 12110 ❑Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />