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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 /> 4 c /� <br /> �1 e, 4 J usar. Le-n7/ Zoning Status; CUP; �* / <br /> OWNERADDRESS (Number,Street,City,State,Zip) ? <br /> 3a(a(. Cdr l �c C -. �trona 1 W 5359 J Variance(#fiction; CSM ) <br /> HOME PHONE �-�/ CELL PHONE E-MAIL ADDRESS <br /> to -- O i S . �, 045 �� Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions $ <br /> AGENT NAME CONTRACTOR NAME <br /> IO...sJ€,e, 9--aSSIYI,uss erg ao r ne--1} Vi-orneS Try-- Site P . uding location I <br /> AGENTADDRESS CQNTRACTORADDRESS O ' e /septic�_ <br /> (7 ! L451- 0 <br /> F 0. �X 49410 Setbacks 3O 25��%� <br /> (City,State,Zip) (City,State,Zip) <br /> Y►t G,d i.so✓' LOT 5371 t m adiSon WT Svc I - ��� Lo w.' 1 <br /> PH N P k)6/NE Site PIan�pproval from <br /> � rv.(e . Li/ $) 133 — 2���- applicable township. /�j4- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> �O�rf� r �� r.� �S.CA�► �4,� c.,�V ,; •C.Qa Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro ert / ' / <br /> PARENT PARCEL NUMBER. <br /> r CURRENT ZO1NING: ACREAGE: P P y <br /> ❑ NUMBER V�DO ( `" 15 3'o �S { ' ••9� frontage drawn to scale. // <br /> TOWNSHIP: "� r _ SECTION: <br /> r t j d of �i 1 at 1/4: 1� '/4'/4: N Driveway permits _ <br /> ADDRESS: lie, q (State,COUnty, own <br /> 31 66 �f I 1;20 V— C-h Y ,ron GL 1 1)� 5?JS 13 �� Sanitary p- ., s <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3 Be rn` P01Y* 3 (Public�• <br /> PROPOSED PROJECT INFORMATION Aar REVIEW <br /> PROJECT DESCRIPTION: �q <br /> AA al ; -1-i'llr‘ 3 0 1 6 C )( / ?' (9 f° /-- ----'a- .e/ - ---,:-- -. ❑This project is a new building or structure. 4 `' Ift �. _ S <br /> lizf This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: � �� � <br /> nSEWER SEPTIC 0:47,-.;,-1.M. { <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: $hE Pt d (�tt Clfltl -,--" <br /> (Outside dimensions including unfinished area, attach p,�t $es and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ((��J .1 ,s ii TOTALSQUARi FY! E: + ,, s s <br /> i $ `.`aa . <br /> 2ND FLOOR: 3RD FLOOR: 4 <br /> ESTIMATED CONSTRUCTION COST: V and avail 5 ,: >b <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 20 �b <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yeslo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �No El 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? ❑Yes �No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/a ) (leave blank if none) , <br /> 6. Is a location survey required? (see reverse) vg Yes No ['Don,t know <br /> 7. Is this to correct a violation? Yes No <br /> ACAU BE SIG NE <br /> 3 0 , (Continue PPLI on TION Back)M ST <br /> 545-112(4/08) <br />