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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW R NAME <br /> iQ Ro r/ <br /> l r't` AZoning Status; CUP; A —I <br /> O rR DRESS (Number,Str9e City,State,Zip) /� <br /> / ' op'- 7 S,o`N D e-1 O f P Deed Restriction; CSM <br /> 5'3 S4' variance(# ) <br /> HOME PHONE CELL PHONE E-MA/�I ADDRE <br /> G Dg.1930 LW: t 37i 1 3 D b e 1 & 'Mkt' I °`''" 11 Site Plan drawn to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME �,� <br /> 5(0/,,'�.Z Of(_/' pk ° /J( y$ a Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADORE$§ of well/septic / 4 <br /> 7Y7, ti ¢Are � : 3/ 0/701 -0 <br /> (City,state,Zip) (city,state,zip) a Setbacks <br /> PHONE PHONE /�Site Plan approval from A,/' <br /> ,-y /' -,r ` applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> S- hi a Pr e2 X/ad C a',, 'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: pCURRENTZONI G: ACREAGE: /� Elevation of property '` <br /> ❑ NUMBER (2 /6 9 /0 O>I;2- &2.Q A r I 76 -- rontage drawn to scale. <br /> TOWNSHIP: ,/8V' ; S I SECTIQN a ,/ 2^� <br /> (/J.� O I�j/ ,/. .S L1/ ,�a,�4: !t/ � v�X,driveway perm <br /> ADDRESS: '(state,county, <br /> t/ ji► Pr- D P --lo r '5 �,:1 5 3 532,,Sanita •- •-• <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> PROPOSED PROJECT INFORMATION y STAFF REVIEW <br /> PROJECT SCRIPTION: /� ( tr/ 7 // „ <br /> /"Q C' ( X 53— S /t e . rind � ` � <br /> [This project is a new building or structure. ��r g t 4 i <br /> ❑This project is an addition/alteration to an existing building or structure. � ire <br /> SANITARY SERVICE: PERMIT NUMBER: ° <br /> nSEWER <br /> OEPTIC R HEIGHT IN FEET: E NUMBER OF STORIES: (Not including basement) <br /> r. W1i8 jy <br /> r !: k ;„ 1) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: �1 ''0O s <br /> 3 J / 1 TOTAL SQUARE FOOTAGE: 4, k (";� •,ante ��i / <br /> 2ND FLOOR: 3RD FLOOR: ( Qf ) 7, <br /> Lotion Su vey . <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ $ J, ,�}r� t a <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ �V �Q �w e9 x 4,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑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 ❑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/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 /> (Continue on Back) -+ <br /> 545-112(4/08) <br />