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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 /> (hi 14641 el le_ /k ier i- <br /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> W-5 Ivall dory - )Lich. -1#' 50a Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Lam-a/ -•o`Z 3W a l i/U-►ZI ebe etc,/. ec-rz ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON CTOR NAME <br /> 064'�f- L.l.",I 0" ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Mad/SCr wr 637S/y <br /> PHONE PHONE ❑ Site Plan approval from <br /> (pets-4030 -9g applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .. {.& 614.. i- 44 ; •nei- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: <br /> ❑ PARCEL 0 7a. 3qy-93 Goo.. ,/-_1 1 ,d frontage drawn to scale. <br /> NUMBER �T <br /> TOWNSHIP: SECTION: <br /> M l'al l2 1/4. 1/1/4. ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: n�� <br /> 0 t'd-to � I M r 1-1-3T 5 3"7 9 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION yy �, <br /> PROJECT DESCRIPTION: <br /> 3 - Ca dh. dud 90 ',,e [ '1 "V : <br /> This project is a new building or structure. L <br /> ❑This project is an addition/alteration to an existing building or structure. %' <br /> SANITARY SERVICE: PERMIT NUMBER: ' ',MOWS <br /> nSEWER SEPTIC r' <br /> f b +9 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,I <br /> °` s ;F '4 ; <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: , <br /> 7a�1 4, TOTAL SQUARE FOOTAGE: 4, W(+-'� `k k T <br /> G/ flI . <br /> 2ND FLOOR: 3RD FLOOR: H/A <br /> Tao **% x <br /> Li Revue :- .! t <br /> ESTIMATED CONSTRUCTION COST: $ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �V ��i� '„ 51 <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 12 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? EYes ®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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -0 <br /> 545-112(4/08) <br />