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91- <br /> L / SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNcRR NAME <br /> ,{ <br /> e_i i V EL) 1 '— ❑ Zoning Status;CUP; <br /> OWNEERRAi4DRESS (Num r,Street,City,State,Zip) Deed Restriction; CSM <br /> —l`T 2 L----rdw _ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME t—� CONT CTOR N ME <br /> - , . <br /> c C�j r,.. ` ( ,u ) ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (city,State,Zip) /, l F� (City,State,Ziip) i g. , El Setbacks <br /> Mt7 V z2 ` i lai__r <br /> PHON E p PHONE El Site Plan approval from <br /> (�,O g07—c-t74(p —20(p " ?50c- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Clzc5/ V.?-g-- - AR A-1 LCok ❑ Floor plans to scale <br /> PROPERTY/LOCUTION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUM ER: CURRENT ZONING: .{ ACREAGE: <br /> ElNUMBER 0�v� 7`"lU -q0ZO'GO g-"%1- ( t frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> X 50 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> qz-f-(-2 L�UlL' r-t-.7. ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION r :" " <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: -� <br /> . 7) 9 l LJ C 0 �7 066'1' 13 Zonfrig District <br /> • El This project is a new building or structure. x ,''' t, <br /> KThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: a °�,. Address , , <br /> (SEWER f SEPTIC ew = <br /> HEIGHT IN T: NUMBER OF STORIES: (Not including basement) ' <br /> asement) �, _ -,. <br /> ( #4 e c etl a o ...plaint -ft <br /> a_eland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: �, ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �, ' <br /> BASEMENT: 1ST FLOOR: 44 t <br /> /` jil ,, TOTAL SQUARE FOOTAGE: 1 (slopes,Vd� nce: <br /> 2ND FLOOR: 3RD FLOOR: j W� <br /> �.L� <br /> ESTIMATED CONSTRUCTION COST: Q a available 1 <br /> (Please round to nearest dollar) ♦ ♦ -► ♦ ♦ ♦ $ /���� ,o„� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes K 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 ENo <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) ❑Yes M No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ilk No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />