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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 /> a <br /> L°-L( C /CezSlti 2/Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �/ Deed Restriction; CSM <br /> 5‘ .3 OAK. A4, 0/9.D , /2l dq-4 G t I Variance(# ) <br /> HOME PHONE /CELL PHONE E-MAIL ADDRESS <br /> 6 dg 1 .1, Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGEN AME CONT CTOR NA E <br /> . � <br /> GI L'W/0 O fit,/ 6t--S Site Plan including location <br /> AGENT ADDRESS CONT CTOR ADD 4 SS of well/septic <br /> 305$ t3 C -Cs/If s•tAtu'Q <br /> (Ci State,Zip) (City,State,Zip) detbacks <br /> DWII? or 43 kic7 Skvu <br /> PHONE PHONE Et7Site Plan approval from <br /> L o' Z 15 1 o 17 S-A u. applicable township. <br /> E- :ILADDRESS (t E-MAILADDRESS <br /> - L s i _g'-UD i .i, A, 021 CO -S'IA ulK2 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: C RENT ZONING: ACREAGE: Elevation of property <br /> ❑ NUMBER 6 Fria its 3 W 30 '3 / A— ((;� 1, 19 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /IVA 1/4: 1/41/4: �iveway permits <br /> ADDRESS (state,county,town) <br /> -5433 p,4 K P� ,��o�v._- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ (publi •er <br /> 2 (publi ,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: „x,Y �REVIEW icar <br /> . Ri This project is a new building or structure. , ,6 Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U R <br /> SEWER SEPTIC n ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /9 1 1 Wei l <br /> Shoreland (attaChMentl <br /> AREA TO NEAREST SQUARE FOOT: <br /> dimensions including unfinished area, attached garages and above grade decks or porches) e <br /> Er0S1011 uut <br /> BASEMENT //7 1ST Fl nnR 4( d�rban , <br /> ' / ,414 + TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: 2 ^( � <br /> L7 Review c� er <br /> ESTIMATED CONSTRUCTION COST: Q /�/� and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ I O/ C'" , s, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 21 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes 9No El Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes rL�Ji No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 2 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) Eyes vil No ['Don't know <br /> 7. Is this to correct a violation? Eyes NI No <br /> 14 - APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />