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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C i STOMER TO PROVIDE <br /> OVXNER NAME <br /> nt S Se-hi 1 rn 'e r, roping Status; CUP; <br /> OWNER ADDRESS (Number,Street,CitWState,Zip) <br /> geed Restriction; CSM <br /> al 4. Cate. of 'The_ Pled.plAS R) eke- /nevnAS kJ/ 5 351`7 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 401-Lin fay I sc1,/gym t .,e. Il ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> le-sSce Sc{•1;mt_... �L3 CJvnsoht:,5 L L L Ste Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 1350 vn,ty RdP -16 5-ct, 4.4e-4 ;r.f+a ❑ Setbacks <br /> (City,State,Zip) (City,State,Zip) <br /> M7 Nor-ti, t4 S35-0- <br /> PHONE PHONE ❑ e Plan royal from <br /> bey? - :i,5-3x00 plica a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 'Si.3Co.► / L. '? at rnt:/.Corr. loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑ PARCEL (11/� Or _ Q ( / A- I 3F.3O� frontage draw scale. <br /> NUMBER LJ{p 1Q <br /> TOWNSHIP: o) SECTION: <br /> S i.-G- G 1h: ': //: ❑ Drivew ermits <br /> o eivc. Ma,,d S (stat ,county, own) <br /> ADDR ESS: <br /> 17 el 9- 6 u1.- /4 'AL MpanhiS RP Noe_ /nom Ai/ ❑ Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT •ubf',private) <br /> PROPOSED PROJECT INFORMATION STAFF''R IEW <br /> PROJECT DESCRIPTION: <br /> olr‘.'c.c 4'O',51:-i16., w relp/ace_ its...-_,L,.._s ; � i'tript <br /> . ❑This project is a new building or structure. '--` <br /> . US , <br /> ®This project is an addition/alteration to an existing building or structure. �, <br /> SANITARY SERVICE: PERMIT NUMBER: {k A.o 1M nSEWER SEPTIC N dew! ° $ '` <br /> HEIGHT IN FEET: NUMBER OF STORIE1: (Not including basement) '4 4"°°".„.,;:t"#4` ° <br /> ,��'�etlan• •••• al � <br /> . <br /> AREA TO NEAREST SQUARE FOOT: <br /> €. ( �: 9 i -at) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> 1ST FLOOR: '� °� • F <br /> f <br /> t-) + TOTAL SQUARE FOOTAGE: 4, o:. * st o, f"r, <br /> 2ND FLOOR: 3RD FLOOR: <br /> �� , , : : <br /> r, C�� r <br /> e ix <br /> ESTIMATED CONSTRUCTION COST: $ © ©©� iii o o e o <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ and�ila,- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ZINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes EtNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Q N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan f none) <br /> 6. Is a location survey required? (see reverse) ❑Yes LY No ❑Don't know <br /> 7. Is this to correct a violation? EYes 2iNo <br /> 545-112(4/08) 't \I APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - <br />