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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 /> s .,-St ❑ Zoning Status; CUP; <br /> OWNER ADDRj� Number,Street,City, te,zip) / Deed Restriction; CSM <br /> 3.57 7i) in i ( c/-cr-74,,y � : , 55,55,g- Variance(# ) <br /> HOME PHONE LL PHONE E-MAIL ADDRESS <br /> 1 i • - • C6I A -- X ob.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/) ❑ Elevation of property <br /> ElPARENT PARCEL NUMBER: CURRENT NIN ACREAGE: <br /> NUMBER 0 7/0 3 502 6gei3 _ ) frontage drawn to scale. <br /> TOWNSHIP: SECTION• <br /> T/e0/,�rN� L 3 3 1/4: '/4'/4: ❑ Driveway permits— <br /> -- / /� (state,county,town) <br /> ADDR S: 3 S�6 ��%���H/f/ L ✓\ <br /> CSM: LOT SU pIVISI BLOCK/LOT ❑ Sanitary permits <br /> /V/ t� /,, r (public,private) <br /> PROPOSED PROJECT INFORMATION f AFF EW <br /> PROJECT DESCRIPTION: / '; ;.- „�f , �j `. <br /> Ch ;G(c en �7,p -Zoning DiStr <br /> . 0-This project is a new building or structure. C] ,,ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. :,......ry; <br /> SANITARY SERVICE: PERMIT NUMBER: Add <br /> f SEWER /SEPTIC rtektsue) ,, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) j' i4, , <br /> 1 ' �� © Wet fop t®i,f ¢ ;' <br /> / S; oreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ; _ , % `' <br /> e � s Si`� e, ,� <br /> BASEMENT: 1ST FLOOR: : fit , <br /> / '_ ,l TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: ".-- <br /> U Li t Survey <br /> ESTIMATED CONSTRUCTION COST: $ �.�� �-a1 a o i,,,d x,4, ,,-' • <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ "'f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes MI 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? 2 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ea 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 ErNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />