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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> try1iOS <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Cro`q A ad oning Status; CUP; <br /> OWNER A RESS (Number,Sleet,City,State,Zip) <br /> I g6cL IW,,df- F1 k tbsjra WI S 3S�5 Deed Variance Restriction; CSM <br /> UV Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRE S <br /> (a,: -,.) q-S640 Cf, • dry, a p "mait.c.0 nn it . P -. . -wn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION :nd includes dim- •sions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including I. ation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) III Setbacks <br /> PHONE PHONE [2 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS LL <br /> [j1'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I�Elevation of property <br /> PARENT PARCEL NUMBER: n CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 0(068-344- 8030 —0 RN - ( 3,G c1 frontage drawn to scale.•TOWS HP O V_r�c` SECTION: 1/4 1 1 Driveway .- I. <br /> /a/4: <br /> � <br /> jf§iate,county,to n) <br /> ADDRESS: 11 g ��S T 8 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> CSM: LO <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION EVIEW <br /> PROJECT DESCRIPTION: r <br /> l� au 11,1 Si r;314. -CC/4...o . +-back.. `c(w- 1 6M-1--Frr_1/1 x Zoning District <br /> . EiThis project is a new building or structure. Ud Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. — " <br /> SANITARY SERVICE: PERMIT NUMBER: CY-Rural Address ' <br /> EWER rAEPTIC (new xisting) <br /> HEIGHT IN FEET: r r NUMBER OF STORIES: (Not including basement) <br /> i?�-I a L�1 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) ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> vZ D 69 3 o a o 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> q 50 (° ill 0.0 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -4 ♦ w� �4 and available options. <br /> (Please round to nearest dollar) V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'io QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑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) Efres aio ['Don't know <br /> 7. Is this to correct a violation? [Yes 'lo <br /> ( , APPLICATION MUST BE SIGNED <br /> lik, ', , - -- `�-�' (Continue on Back) <br /> 545112(4/08) <br />