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SUPPLEMENT to Web-App # <br /> ZONING " ERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ME '' ,,,, •• // <br /> 1` I Y� 1C�, �/ oning Status; CUP; <br /> OWN ADD Ey Street,city,State, " Deed Restriction; CSM <br /> �� r V I Variance(# ) <br /> HOMLjPHONE , Taotz, E-MA ILADDR S mod• [-A!7"'608 03 — I SZ �9�0 ��h�11�'(e� W�S4 ' e Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADORE-. CONTRACTOR ADDRESS of well/septic <br /> State,Zi backs <br /> (City, P) (City,State,Zip) <br /> PHONE PHONE ❑ Site proval from <br /> ap abl ownship. <br /> E-MAIL ADDRES• E-MAIL ADDRESS <br /> F r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> El ea�-af property <br /> PARENT PARCEL NUMBER: CUR NT Z NING: ACREAGE: p p y <br /> 1:1 PARCEL - 7 rontage drawn to scale. <br /> NUMBER Q CIO��� on l Q — • / <br /> TOWNSHIP: SECT <br /> ADDRES iv <br /> (sta un tOWl� i <br /> I _1111 <br /> •CSM: LOT SUBDIVISION BLOCK/LOT I=1 Sani ►-rmits <br /> ■ (publ. • rvate) <br /> PROPOSED PI • . • : II • . F E <br /> PROJECT DESC RI' ION: 3h e - )-)r� � +k <br /> • i a f 1 ' <br /> . This proj3. is a new building or structure. ►4, <br /> ❑This proja• is an addition/alteration to an existing building or structure. <br /> SANITARY SERV C:: PERMIT N M AddreS <br /> nS:WER nSEPTIC ° y <br /> HEIGHT I 'ETl NUMBER rF S ORIES: (Not including basement) <br /> EI3 4111, ea2t c r3�� ' . <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimens ons including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST F�L/OOR: <br /> i T (u 4, TOTAL SQUARE FOOTAGE: 4, , •• a d rbance: <br /> 2ND FLOOR: 3RD FLOOR: i <br /> ESTIMATED D•NSTRUCTION COST: $ �/SO OO , , •,,,ft-2:11:1 <br /> (Please rounc t. nearest dollar) y ,,, <br /> 1. The propel is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,iNo Don't know <br /> 2. Is there a w� land or floodplain on or near the property? ❑Yes [I No Don't know <br /> 3. Have you lal ed with the township about your project and are they in agreement? BYes ❑No <br /> 4. Has there ben a zoning permit issued for this property in the past 5 years? El ,No <br /> 5. Is this prof ac associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locaticn .urvey required? (see reverse) Eyes TX No ❑Don't know <br /> 7. Is this to cor ect a violation? Eyes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />