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12(0'97 54, <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> J e fcc e ' SCigtiarZ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM �� <br /> 3717 Grcancl ler eil 5,., a?-s t.,, 53Sgo Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan dra to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AerISMJ Oec . f >•so, . ❑Site P n ' eluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well ptic <br /> (City,State,Zip) (City,State,Zip) ❑Set CS <br /> ,41a-„-r 110,co S3s 72 <br /> PHONE PHONE El Site Plai -• ,r I from <br /> 6oy-1 f-3 , 6 applica. - to ns ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Floor pla O scale <br /> T•i , a&I S., duk c.,J , ,to fi <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) 1=1 Elevatio o roperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL d$ �Q,, 031- 'U/a�© frontage raven to scale. <br /> NUMBER O <br /> TOWNSHIP: i <br /> PROPERT• <br /> Ke. /4; 1%+A, ❑ Drive ay it e <br /> (state n ,t wn) <br /> ADDRESS: <br /> S3 nr" As ,Q 6ovz <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sani ry Its <br /> (pubs te) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Pet gdc ❑ Zoni istrict <br /> . This project is a new building or structure. ❑ PermitteVe? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: CI Rural Ad s <br /> FIEWER PEPTIC (new/e I i ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Li Wetland/ I' •-: .in/ <br /> Shore!. ( tt.chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosio trot permit <br /> (Olt. j TOTAL SQUARE FOOTAGE: ,l (slop St rbance, <br /> 2ND FLOOR: 3RD FLOOR: / <br /> filling cress) <br /> �/ � ❑ Rev' tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and ab options. <br /> (Please round to nearest dollar) 14:30 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4141 EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres !�►o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? U'e` /No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes tElNo <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 to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ <br /> 545-112(4/08) <br />