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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C •-TOMER TO PROVIDE <br /> OWNER NAME <br /> M:,k" 'p. 'A -fplw3 D oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> kk..... =(.... lip 0630 ariance(# <br /> )�� H ws+R CE PHONE S <br /> P7 970-0 6 b{} h?v-O�7• M,�,r'•k 0'4 $ 2.0 @ 0$^^••1 •twr, ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> M.0A,,,t,tt.L1 lyvl.r.•rf' Ste Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip etbacks <br /> trot" S 1^/44- % IL L 0030 ❑ • e Plan royal from <br /> PHONE PHONE <br /> $A `110- 0615 applic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS IOOr plans to scale <br /> our •h . 20 e ,„vv.,:1 , c.ow` P <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PA:. N MBER: CURREpf�ZONIt�G. ACREAGE..., frontage drawn to scale. <br /> PARCEL ��:'� �_1 :t•� ���_1. <br /> TOWNSHIPER O • /O^ ` Oil-136 -0 SEC�Ot�;_ 1 1 El Driveway permits <br /> l J 1ni)5oc JJ??�Vl �4%' (state,county,town) <br /> ADDRESS: / M , _1 <br /> ��� ` 1 0 04 Lo\me__ EN Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 7 W;nit S•r Cscworg <br /> PROPOSED PROJECT INFORMATION ST 811(1EW <br /> PROJECT DESCRIPTION: <br /> . ®This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. R� . <br /> SANITARY SERVICE: PERMIT4NUUMBER:2 'V. #c @$5 <br /> G7lf T -�J ~N€ { <br /> SEWER nSEPTIC ? � '� � <br /> HEIGHT IN FEET: NUMBER OF TORIES: (Not including basement) �'' <br /> AREA TO NEAREST SQUARE FOOT: <br /> an 1 <br /> (Outside dimensions including unfinished area,attached garages d above grade decks or porches) <br /> BASEMENT: ` „ 1ST FLOOR: / �� <br /> /1 T C.��) j TOTAL SQUARE FOOTAGE: j (: °" } € I�4? <br /> r y,TE 2ND FLOOR: r 3RD FLOOR: . [,away ESTIMATED CONSTRUCTION COST: � 00 " , - <br /> ♦ ♦ i'l (i1::.):( );)(t: max. - <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 liNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes N ❑Don't know <br /> talked with the township about your project and are they in agreement? EYes o <br /> 3. Have you P Y <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 one) <br /> 6. Is a location survey required? (see reverse) Yes ❑ o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> !j.:) APPLICATION MUST BE SIGNED <br /> r-U . %)((i) A (Continue on Back) ♦ -* <br /> 545-112(4/08) <br />