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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C STONER TO PROVIDE <br /> OWNER NAME <br /> r C X.A//t//✓� <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Wing Status; CUP; <br /> ��l�� eed Restriction; CSM <br /> S`�/4..woiv 9/ria C4x4.82�A c wl 3 3s'o? ariance(# ) <br /> HOME PHONE CELL PHO E E-MAIL ADDRESS <br /> AL- °p `?6 9 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ®a P c /v tit e F l< ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> zy /9 /307 RD <br /> (City,State,Zip) (City,State,Zip) <br /> Setbacks <br /> e0,444 is RX•0f c (...‘1..4-' 4-3 r-1. 3 <br /> PHONE PHONE <br /> y� �� Site Plan ap val from <br /> ‘a Sr— / applicabl wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Elevation of property <br /> ❑ NUMBER v6 ) ... '�a SS30^z ,4— 1��,,C) /p frontage draw o scale. <br /> TOWNSHIP: <br /> �tA-/R.� �'—:RSA s( I6 /4. N %oh: ■&) ❑ Driveway ermits <br /> ADDRESS: (state, unty, awn)i(c <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ❑ Sanitary • • <br /> ate)2 <br /> public, .rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVir� <br /> PROJECT DESCRIPTION: F <br /> pot_�. S iLl 6i "/�. 3 ( zgoilgost,ct <br /> • [],This project is a new building or structure. <br /> S8' <br /> ❑This project is an addition/ teration to an existing building or structure. it <br /> SANITARY SERVICE: PERMIT NUMBER: ,iF(n +i °g <br /> SEWER SEPTIC "1�zs ,�,_ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not i cluding basement) <br /> AREA TO NEAREST SQUARE FOOT: r S "=, i { ' nt <br /> (Outside dimensions including unfinished area, attached •.rages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �EFb ° • Ot <br /> / '��r ■' TOTAL SQUARE FOOTAGE: + s�� <br /> 2ND FLOOR: €€ �-a jr <br /> 3RD FLOOR: /� ^, '& <br /> lJ "--'' c" o Su T <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "♦ '"► $ Q 0 d U <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 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 a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6.. Is a location survey required? (see reverse) ❑Yes E3No ❑Don't know <br /> 7. Is this to correct a violation? Dyes I2 <br /> J APPLICATION MUST BE SIGNED <br /> 545-112(aioa) / n (Continue on Back) ■ -♦ -∎ <br />