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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 l/ <br /> eda l-v.ri �!i Sj k'i� ❑ Zoning Status;CUP; <br /> OWN DRESS (Number,Street,City,State ip) Deed Restriction; CSM <br /> 2 7‘2 1eren,5 K,4. r l r 66 .9�:.v,"� '...)-7.f......-_-1O Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> S7 - gRz a '1 e ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /V37't _5(re e,L,Lrw, . Ap,.k ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> G3n_5iz.viez5 ,c).- Cry/.` sus <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> EI6' x`92- 6 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> .- o _ _ "Al <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURB NT ZONING: ACREAGE: G <br /> ❑ PARCEL MBER Cq/f)13 6,90- _ I 0- D frontage drawn to scale. <br /> NU <br /> TOWNSHIP: SECTION: <br /> 3 '/e: /4/4: ❑ Driveway permits <br /> A uDS S: � . 1 (state,county,town) <br /> n) <br /> -� <br /> Z 7‘ z ?r ,u s K :.i to Or j � El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ;*Too'ravioli'', <br /> PROJECT DESCRIPTIO <br /> / x O Como/ Le u, ( ArJ , , <br /> . ❑This project is a new building or structure. ', ; ff tiso <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: � ut-al Address <br /> nSEWER SEPTIC / <br /> HEIGHT IN FEET: NUMBER OF STORIES: 1f lot including basement) <br /> S ore� ��d (a ) <br /> AREA TO NEAREST SQUARE FOOT: 4 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) y <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: j z es,d�ctrbanc e, <br /> 2ND FLOOR: 3RD FLOOR: q <br /> 7 0 Li Review r e <br /> ESTIMATED CONSTRUCTION COST: and avaabla i' : ,'' <br /> ((Please round to nearest dollar) ♦ ♦ "♦ ♦ -+ ♦ $ !I iD� <br /> ) i ice,,,". <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [pNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes r o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes R„ o <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 a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes �(Jo El Don't know <br /> 7. Is this to correct a violation? ales ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />