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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 <br /> l ,,v\ �{- <br /> NE,,,v, C ( oning Status;CUP; <br /> OWNERADDRESS (Number,Str et,City,State,Zip) Deed Restriction; CSM <br /> _ S 3 S%/ --7q, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> .f=r3 ■ 3—? - 3014 a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w /septic <br /> (City,State,Zip) (City,State,Zi Setbacks <br /> PHONE PHONE II • - Pla a.• oval from <br /> applic.• e•ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E atlon Of property <br /> PARENT PARCEL NUMBER: CURRENT ZO I ACR GE: p p y <br /> ❑ PARCEL 0�Oro ate/ci't/S p A— a-('i rontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �m 1�4: 1J r 1�41�4: Drive rmits <br /> ADDRESS: 1 ,4 - (S Unty,town) , <br /> '- ,-c3.'- ,-c3.53- S3 511 a Sanitary sermits j���1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publ• / y �/ <br /> Y v <br /> PROPOSED PROJECT INFORMATION F REVIEW <br /> PROJECT DESC ION: <br /> S S A x ) ZIrtC}Ile <br /> ❑This project is a new building or structure. P ttted Use? <br /> ❑This project is an addition/alteration to an existing buildin or structure. <br /> SANITARY SERVICE: PERMITNU ER• f Bill . rat Address <br /> r1SEWER • EPTIC <br /> HEIGHT IN FEET: J ^ NUMBER OF ORIES: (Not including basement) <br /> J ,'t,,,, ,,,,,. •• ' '„ <br /> , ` 8 '-4 Y`M meat) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) I <br /> BASEMENT: 1ST FLOOR � c*rt .'y L•j 1 < 1 TOTAL SQUARE FOOTAGE: �„ „ r } i,�y �r <br /> 2ND FLOOR: 3RD FLOOR 1 )—S \ <br /> ESTIMATED CONSTRUCTION COST: I C S andeyaila. .€,ate- <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No ❑Don't w <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? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑ es JNo <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? ❑Yes —q—No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />