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1 41 k' °° <br /> SUPPLEMENT to Web-App # <br /> ZONING " ERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER,6E• �j �? <br /> r !1L `�" G1-�, l� -��Y S ❑ Zoning Status;CUP; <br /> OWNER ADORE• (Number,Street,City,Staatte_,Zip) Deed Restriction; CSM <br /> 3 To6•n t! d - b,2 '01 0 \ 55S-3 . - Variance(# ) <br /> NOME PHONE i ' CELL PHONE E-MAIL ADDRESS <br /> (bo$)'1 t DLR. (rope 44,44 -SOLI r SC.00 b Ka la d 0 6' 0-hoo .0 rM ❑ Site Plan drawn to scale <br /> AGENT INFDFtMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> \sue -G S cK� ❑ Site Plan including location <br /> AGENT ADORE-. CONTRACTOR ADDRESS of well/septic <br /> 3-121" 114-1-Yk + -J . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> (608) y —co q p- applicable township. <br /> E-MAILADDRES• E-MAIL ADDRESS <br /> Sono b, .. t0.dDO @ alloo•et..N., ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZON ACREAGE: <br /> ® NUMBER 0810 -031 -b%69-S � # W frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 6 vAA(-,-e <br /> /4: ,/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> �� <br /> r ' CI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 8do 0 0 (public,private) <br /> PROPOSED PROJECT INFORMATION S REVIEV14 <br /> PROJECT DESC• • ION Y <br /> . j2 This proj-•� is a new building or structure. 0 F �% <br /> ❑This proj-• is an addition/alteration to an existing building or structure. <br /> SANITARY SER PERMIT NUMBER: 0 Rural Adress - <br /> :WER 'SEPTIC (n•, ° f <br /> HEIGHT IN FEE NUMBER OF STORIES: (Not including basement) �° <br /> �. 7 <br /> AREA TO NEAREST SQUARE FOOT: " � �' <br /> (Outside dim= sons including unfinished area, attached garages and above grade decks or porches) i% yl° <br /> • on ltrol permit <br /> BASEMENT: 1ST FLOOR: w <br /> ? 4, TOTAL SQUARE FOOTAGE: j, • * •a , <br /> jjl€ e o <br /> 2ND FLOOR: 3RD FLOOR: �� Gi j :'' f <br /> ESTIMATED INSTRUCTION COST: .. y g � �� <br /> (Please roun' to nearest dollar) ♦ ♦ "� ♦ "� ♦ •V "�0 ,,,O. ,,, <br /> 1. The prop: 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 -tland or floodplain on or near the property? ❑Yes 1 No ❑Don't know <br /> 3. Have you al ed with the township about your project and are they in agreement? ['Yes No <br /> 4. Has there •:en a zoning permit issued for this property in the past 5 years? 10Yes ❑No <br /> 5. Is this proj-c associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a Iocati•n .urvey required? (see reverse) --gY p2 o ['Don't know <br /> 7. Is this to c•r ect a violation? ❑Yes a o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ - <br /> 545-112(4/08) <br />