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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> C`rY"‘zr t s(-4\'\lQp 71 \\1i°4?-i1 • Z ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / eed Restriction; CSM <br /> �� C–� a L ' 1'L,� ) , --?- ----1--) ariance(# ) <br /> H 1ME PHONE L PHONE E-MAIL ADD- <br /> 3 - `a ALA.4 Q 1._Q Ot h Rte^I0-\6 <br /> . Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan proval m <br /> a•plic a tow ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor p ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 2 PARENT PARCEL NUMBER: CURRENT ZONING:(http://accessdane.co.daAneR.EwAGLE Elevation of property <br /> NIPARCEL ( U' ,c'l'S DC) .—a frontage drawn to ale. <br /> NUMBER �I ' <br /> TO NS SECTJON* y: I " ( IRA: () ' " ❑ Driveway rmits <br /> SEC-11101 (state ounty,town) <br /> ADDRESS: C <br /> CSM LOT �a f UBDIVISION BLOC,O� ��❑ Sanitary .' its <br /> 135 (publi , .rivate) <br /> PROPOSED PROJECT INFORMATION 14'4 ' <br /> � AFP IEW <br /> r 'PROJECT CRIPTION_:cD c <br /> �O x , <br /> . District <br /> This project is a new building or structure. 4 "1.2 <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U V` e ° <br /> SEWER SEPTIC (rtewiem ,;. <br /> HEIGT: 1 NUMBER OF STORIES: (Not including basement) <br /> .-e414 *• e7 PL(C>i <br /> Shot. i . , attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: , * t <br /> 'C- O TOTAL SQUARE FOOTAGE: ,, .. i ''i t" t , <br /> \ film ,# SS) <br /> 2ND FLOOR: 3RD FLOOR: �` CD'n J Location utte f � ` <br /> ESTIMATED CONSTRUCTION COST: B av - options..,,,', �/ <br /> (Please round to nearest dollar) $ I GOO . ,,ry <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes I11 No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes N No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ei 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 ,01 o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ,■ No <br /> 4(1 _______ <br /> APPLICATION MUST BE SIGNED <br /> 70 (Continue on Back) <br /> easllz(4/08) <br />