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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 /> S� / / L��� [ ertirtg Status;CUP; <br /> OWNE D ES (Number,Street,City,State,Zip> Deed Restriction; CSM <br /> // �i-0 d �i ��i v °2� Variance(# ) <br /> HOE PHONE CELL PHONE AIL RESS <br /> � ��� �o ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location al <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE 1=1-So <br /> app Ite abl Pla towpprnship.val from <br /> E-MAIL ADDR <br /> E-MAIL ADDRESS <br /> ❑ Floor ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) rn evatlon of ro ert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: A REAGE: L!Y" p p y <br /> PARCEL r ) frontage drawn to scale. <br /> NUMBER 0--cc),, j�3 g 0/10 L' ,0,/ P <br /> ❑ <br /> TO IP: SE TIO <br /> U n. '/a: S '/e'/4: Drive p= its <br /> ADDRESS:/ S CJ (state, nty,tow_tt� <br /> 1 lull l — Sanita+ p- its �' <br /> CSM: • , SUBDIVISION BLOCK/LOT <br /> r (publi •;vete) 0 ' <br /> PROPOSED PROJECT INFORMATION <br /> PROJECJ DESCRIPTION: �--- <br /> his project is a new building or structure. y <br /> p This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERM! NUM <br /> flSEWER SEPTIC (� lr� <br /> HEIGHT IN FEET: LL N BER OF STO ES: (Not including basement) -„ <br /> il"'a// -S ANIR(4- .S er r , ""iia , o ' <br /> A TO NEAREST SQUARE FOOT: � � <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) € <br /> BASEMENT 1ST' LO { <br /> e TOTAL SQUARE FOOTAGE: , - 't « <br /> D IT <br /> 2ND FLOG 3RD FLOO� «� �� <br /> '6n-7° <br /> ESTIMATED CONSTRUCTION COST: I { SSA , <br /> (Please round to nearest dollar) ♦ ♦ "♦ <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? Dyes �No <br /> 5. Is this project associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 4 No ❑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 />