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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 /> )--m il A 't., N-5,3 K"u ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> '7/0 4 f i∎\ 5-k eye U Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS r <br /> E 6 `.∎ (sC o'�a S — �o b 0 L Vm-,›¢�u. ' U v\-k54- cO ❑ 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/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL c I J?2 \ r - 1 S frontage drawn to scale. <br /> NUMBER tl.l Q(J <br /> TOWNSHIP: SECTION: <br /> k,t)C ,/4: ,/a,/a. 1=1 Driveway permits <br /> '� (state,county,town) <br /> ADDRESS: S 2 G 0 V�1nt &v./ , \ <br /> CSM: LOT SUBDIVISION BLOCK/LOT 1=1 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> CO(A6f0 U Zq < District <br /> . [-This project is a new building o structure. O ° z , <br /> � Pitted� , <br /> ['This project is an addition/alteration to an existing building or structure. �, x� ,� . <br /> SANITARY SERVICE: PERMIT NUMBER: U RUI`Al '` <br /> nSEWER nSEPTIC • <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �F <br /> E., r{ d (attach a. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) `ro%'` n <br /> BASEMENT: 1ST FLOOR: % �, It <br /> j TOTAL SQUARE FOOTAGE: ,, lOO ,�:� r <br /> c A =, <br /> /� &i { i �L{W�c� <br /> 2ND FLOOR: 3RD FLOOR: ;%f <br /> 6° - W Location SuIry <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ♦ ♦ $ 1 d 6c r o z and a `O <br /> (Please round to nearest dollar) �' r,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 133-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? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ <br /> 545-112(4/08) <br />