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0 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> JEke Sieci iA ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (N}�mber,Street,City,Stat Zip) '` _ <br /> IS& Y IV 'E� 1-- rC V�(�L�`) t� S3S Deed Variance Restriction; CSM <br /> t O 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (oo? P331 - ' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAMF CONTRACTOR NAME <br /> O�t\ i .3 \ h2 ts Jo IAN L42412-6 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> C x,41 Pax- /u E <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> C--- 14_PfDrxsa , wt 531t! <br /> PHONE PHONE El Site Plan approval from <br /> C ‘,C43 511- /4.5-5 applicable township. <br /> E-MAIL ADDRESS E-MAILA DRESS <br /> A9�a r t5® M`O&•co Ai ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUM ER 016 -24'2-81s 1 • <br /> . ,54 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Ouo J of t4I1Jt T0� ' •7'8P 1/4:G%kSEc„ 1/41/4: c ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: d� <br /> 1 Sao c�ow R. ` `Q� ik-E. El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> 13; . ' 41 . ) . : • ■ e : i i : • k ,wstu REVD <' <br /> OJECT DESCRIPTION: $ � C. g 1 y s 6 95 <br /> t , � <br /> . IMI This project is a new building or structure. 'M14*''emitted Use- <br /> "•7 <br /> ®This project is an addition/alteration to an existing building or structure. �7 - <br /> SANITARY SERVICE: PERMIT NUMBER: L:Rural Address <br /> f SEWER SEPTIC newt ISti�) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> £ A <br /> i N6° nt{ <br /> :. <br /> e a ''(attachment) <br /> AREA TO NEAREST SQUARE FOOT: x <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) aEr y f- <br /> - <br /> � � `I� tra perm it,,� 9. <br /> BASEMENT: 1ST FLOOR: <br /> 2�r 4Q I + TOTAL SQUARE FOOTAGE: 4, ist n , <br /> CJf.� +J <br /> 2ND FLOOR: 3RD FLOOR: �; ;- <br /> l 2O S0 4 Review Location Spivey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and evade options. <br /> (Please round to nearest dollar) $ ‘cab. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes IS No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Ez No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ri Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Z No A <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 fl Don't know <br /> 7. Is this to correct a violation? ❑Yes N No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />