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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMI E } 3 T � 1.-- �'o"' D1\"( <br /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> `p']I --1t-tP-ONsON ' , , W l 353 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> g)/(v2 y�{q' 3(o-1( �1'�R.IVSor'S 'AEMR'L. . <br /> • • ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Li Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL J frontage drawn to scale. <br /> NUMBER C 51 2--- 3_ 13'0 ZO -(0 �. <br /> TOWNSHIP: SECTION: <br /> -Pi15\04 '/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> LQ'7 I Rod S ZO? j ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION SF REVIEW <br /> PROJECT DESCRIPTION: <br /> t J11) 43k1 P-NW t'A tiM 6 N2A6E• 2c, x yy C - <br /> • 3 8 f 'yIr A,. <br /> • El This project is a new building or structure. <br /> f?@tTGIfteetAl� - jay, <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U Ru trey - <br /> (SEWER nsEPTIC #� � <br /> HEIGHT IN FEET: 11-1 ; U <br /> � NUMBER OF STORIES: (Not including basement) <br /> /1t- LI ViletiOciffloodplaint <br /> Shorelant atta hment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) '. f . cot <br /> BASEMENT: 1ST FLOOR: / "//„ <br /> 1 I 1 TOTAL SQUARE FOOTAGE: l 1 �es,distl nce, " <br /> 2ND FLOOR: 3RD FLOOR: s' 1' .�.. / <br /> 1ILH- <br /> ESTIMATED CONSTRUCTION COST: e ', t;';;�, <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ L4-7�6� /, a °t <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? ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? El Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -0 -► <br /> 545-112(4/08) <br />