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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ME <br /> STD Ca1-�Cl k �-L-�- ❑ Zoning Status; CUP; <br /> O RADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> x (02-030 S f)1:d 1-ciu -^-�= Ss-z, '?2 -030s— Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (v�31'"`f I Sy t ' 0 -111e-S1'"+ - k--`• -P1/1') I-1❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> J ,,,e. c� . 1 ls os� C, S cT <br /> -,..., ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR /11 /A'TOR ADDRESS of well/septic <br /> ? ^ Co <br /> -(City,State, P (City,State,Zip) ❑ Setbacks` �7_03of u <br /> PHONE PHONE ❑ Site Plan approval from <br /> (Q0S,.3 t41 S--`1 Lao _ S3c.„,—9 jo D I applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ..� <br /> ,� elk,iv -��-'c,..,, l.�`,,>7, r aC pr , ,� Imo „ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL 4(-- frontage drawn to scale. <br /> ❑ NUMBER ��o�_ S3-'ycpo�S C ' 2 �/ <br /> TOWNSHIP: nn SECTION: <br /> 1-1 .� 6 k zA d , _s- '/4: '/e'/4: El Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> (0�l`1 5c� r Pokr) fv); cAteiv_ ��-i S 3 Z El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION p REVIEW„ <br /> PROJECT[ASCRIPTION: s <br /> e( S f+ o 11-14�, c."-.1-<_(--(. ‘,<.._ (A) A C3 Zones Distict <br /> . ®This project is a new building or structure. c3, , # Us <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ! •-2 PERMIT NUMBER: C e <br /> fSEWER <br /> SEPTIC (new/e � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4” '' '. <br /> (c l 1 ' L Wetland/Foodplain! <br /> AREA TO NEAREST SQUARE FOOT: SOtli (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) x <br /> BASEMENT: 1ST FLOOR: i �g�: €k sli"lt ' _' <br /> ii ti^1t Ira+° <br /> _ <br /> 4, TOTAL SQUARE FOOTAGE: ,, /� �t I'1C��. <br /> 2ND FLOOR: 3RD FLOOR: ? <br /> ----- <br /> ----- -75-0° Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: „ 't a ,s '1.84 s ...." <br /> (Please round to nearest dollar) ♦ . ► ♦ -► Z( Oct' y'/ ;' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ©No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? FJ 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? El Yes ©No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -► -0 <br /> 545112(4/08) <br />