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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 /> AAPor1 145-111,1A VA ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction; CSM <br /> '+S {, 'INOSoa- ?..D . I wt►4OSoF I w I S3SYt$ Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 06.2°9'3008 6 08-tom- 00; &Aro,+ •V5h4v1.r- Mc ‘.n cvn5wc1lu,-c..4.' Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mc 44hn (APhSTR.VcTI u►-t IN(. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3L 12- Lef611,4 Arc . <br /> (City,State,Zip) (City.State.Zip) Setbacks <br /> PHONE PHONE v l S 3 lI4 'Site Plan approval from <br /> 6 08. Zy 1 - 5515 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> . Oftt. I+OIZ/V∎ Mt5i,tiKow. ,XFloor 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 /> ❑N EL b o1�t-3A3-63f35-O A—1 33/l31 5F. <br /> frontage drawn to scale. <br /> NUM UM BER <br /> TOWNSHIP: SECTION: <br /> 6RtSToL 3 O y4: SE '/4'/4: s"kJ ❑ Driveway permits AFriA <br /> ADDRESS: ^ (state, county,town) <br /> (,or 65 15(24s-col- G QOC4s 3 i 1 tiP Gf t ki <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 6S B4(STo(, 4POD Y (public, private) AF-tta <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NEw 1-10 vie ❑ Zoning District <br /> . This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER OEPTIC (new/existing) <br /> HEIGHT IN FEET g^ NUMBER F STORIES: (Not including basement) <br /> I Li Wetland/Floodplain/ <br /> Shoreland (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: ❑ ErosionControl permit <br /> 140 14-60- <br /> vv- 3 6 7-5- 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND Fi W A Ol� 3RD FLOOR: p 3 IC <br /> /v ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 40 /000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Ives ❑No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes ENo RDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves 'rNo <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 No Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) ✓�� �� (Continue on Back) —► -+ <br /> Maroh . 4S{°;�k1— MC�tih)1cv�5F ti • 444 <br />