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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 /> Debra_ I � lErzoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ,R-734 Thrt,GS h Lahti Co f-to q 6v 6-r-DE7 G 'J 7v7.35,97 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIYA RESS <br /> &Of-a7qa(D QO on Je&5- /, / 4 'M I b 0°/Y1a/ • IDI/7 r Site Plan drawn to scale <br /> AGENT INFORMATION 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 /> PARENT PARCEL NUMBER: CUR ENT ZONING: ACREAGE: P p y <br /> ❑NUMBER O 71 ' D cy - K.,` , , q-7 ontage drawn to scale. <br /> TOWNSHIP: _14,SECTION: <br /> � Driveway permits rD eit, C7r011e, '/4:_ '//: <br /> ,-tate,county,town) <br /> ADDRESS: <br /> �7 3� — r h Lot Ai G co,d �c�O �/o wa Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: G� Zoning District <br /> . ['This project is a new building or structure. Permitted Use? <br /> Z-This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Ru - ,ii;". <br /> EWER EPTIC ( /e)dsti `! <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wettand/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosion Calntrol permit <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0t Sol._ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) 1 Sao.d O <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? nYes 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 EINo <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 irls. o ❑Don't know <br /> 7. Is this to correct a violation? [Yes al No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -+ <br /> 545-112(4/08) <br /> pi* 0 a..9 Ya4f41- 'i)'-- <br />