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SUPPLEMENT to Web-App # <br /> ZONING " ERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME <br /> 1 i ' ' t 1 Lk . J Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ed Restriction; CSM <br /> 48q (F. i 14li Ctky°a.,c) R ariance(# ) <br /> HOME PHONE 1t// CELL PI-k NE MAIL ADDRESS <br /> -S 7 • -:•.a2 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 4°' L i ...-e--'6,2 J ,, - C, , fJ(c/v%, ❑ Sit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> /.Z f L tfC•fet S-c Jr. 5? Le hr vcv,/ 4,- <br /> (City,SUState,Zip) / (City,State,Zip)/� Setbacks <br /> PHONE / tt I S 3S 43 S`vl Ll C ✓r�1( .< [`Al ti <br /> 3��7 t� <br /> PHONE ❑ Site Plan royal from <br /> ,.. . 3S-- gc e) Z 11 - _ 3 5 , /B tio ap is etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS l <br /> ❑ loor plans to scale <br /> PROPERTYLC)CATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL N^UMB R: I CLRRENTZO ING: ACREAGE: P P Y <br /> ❑ PARCEL ER U M.... I LiV� -- '∎ ( $ frontage drawn cale. <br /> TOWNSHIP: SEC ON: , 11 <br /> 't kt `� 1 •. ,v1� 1/41/4: ❑ Drivewa ermits <br /> ADDRESS: (state ount own) <br /> 4--(a. 42 (-419 LI G/r^("4✓'t I ❑ Sanit permits <br /> CSM: LOT S�1,1 I���Q 1 - � BLO OT � (• IC, private) <br /> PROPOSED PI4OJECT INFORMATION //�tJJTT C ` ::- '. ' : "REviEW <br /> PROJECT DESC RI•TION: <br /> . ;,This proje. is a new building or structure. <br /> ❑This proje• is an addition/ Iteration to an existing building or str cture. <br /> 4 <br /> �a <br /> SANITARY SERVIC:: PERMIT NUMBER: „W\ 4 : i: <br /> 11S:WER EPTIC <br /> E /;/* <br /> HEIGHT FEET NUMBER OF STORIES: Not including basement)oz._ AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimens ons including unfinished area, attached garages and above grade decks or porches) d y <br /> BASEMENT: 1ST FLOOR: � 6 �$ , :• `p ` { ur ance,j TOTAL SQUARE FOOTAGE: j iT - <br /> 2ND FLOOR: 3RD FLOOR: % <br /> U <br /> y/f) cel <br /> �t a f W ti3� ' 6 <br /> ESTIMATED Co NSTRUCTION COST 5-:,i'�' <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �/��� t1;, <br /> 1. The propert is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a w:tland or floodplain on or near the property? ❑Yes o ['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 b:en a zoning permit issued for this property in the past 5 years? ❑Yes ❑ <br /> 5. Is this proja• associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if one) <br /> 6. Is a location -urvey required? (see reverse) ❑Yes ❑Don't know <br /> 7. Is this to cor ect a violation? ❑Yes o <br /> gQDAPPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► <br /> 545-112(4/08) if , <br />