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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER E • �' <br /> .a0i.nri . Ivt.a.re sc.. 5-t-ei'ex dor ' <br /> A--144 <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Nu er,Str t,City,Stat Zi ) 11 eed Restriction; CSM 5-6 p <br /> 3i 3 1�,� -e , �I 3 met rS ( C IBS 3�i�� Variance(# ) a <br /> raBH6E CELL PHONE E-MAIL DDRESS <br /> N . ,((��5'304'� cJOS 2. •L( • ` J�'o 'er. Cam Ie Site Plan drawn to scale ih <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions /�/� ' <br /> AGENT NAME CONTRACTOR NAME I'1V, <br /> t-1 Site Plan including location <br /> AGENT ADDRESS CONTRACTORADRECENED of well/septic ©�y2 /0,0 <br /> (City,State,Zip) (City,State,Zip) Setbacks C7/5 0//0/5,D <br /> PHONE PHONE j j 2 5 2015 FrSite Plan approval from <br /> applicable township. �j� <br /> E-MAIL ADDRESS E-MAIL ADDRESS r,. <br /> RAZING&DEV`�0P" Floor plans to scale <br /> r <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co4ane.wi.us/) Elevation of property 4/© <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p <br /> ❑ PARCEL / / 3/. Y frontage drawn to sca A j� <br /> NUMBER Q 3G(ag/a c`7�a �(OcYa S .r <br /> TOWNSHIP: / t SECTION: 1/414: <br /> N t��,_ .y perm' <br /> I"1e C1ylY\0 °.� (Z /a: /{/hf t ount town <br /> ADDRESS: �iiiii� <br /> ()3I 3 ST'V"-Z-- �� "7 3 n��sl�.t l �z 53 ss9 Sanitary��••'ts <br /> CSM: LOT �� SUBDIVISION BLOCK/LOT (public p ' <br /> PROPOSED PROJECT INFORMATION '� IEY <br /> PROJECT DESCRI N: <br /> e 1a Pox c.�.. 4 Pa ro o, � <br /> . ❑This project is a new building or structure. Zt) c' 2- 2-f- f,� <br /> This project is an addition/alteration to an existing building or structure. p r x <br /> SANITARY SERVICE: PERMIT NUMBER: ; �� ;° . <br /> nSEWER SEPTIC er,,, <br /> HEIGHT IN FEE `, r NUMBER OF STORIES: (Not including basement) [ <br /> I , 1 't - <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimens ons including unfinished area, attached garages and above grade decks or porches) 5 <br /> ��! EII�Stc� �,s>�Y'Q� � � , <br /> BASEMENT: 1ST FLOOR: /� y <br /> y V j TOTAL SQUARE FOOTAGE: , + ,,° '$ 0 ° * s , <br /> filllln <br /> 2ND FLOOR: 3RD FLOOR: (1 0 <br /> Location Survey <br /> ESTIMATED CONSTRUCTION COST: a c Me c �Y 43 4200. no(Please round to nearest dollar) ♦ ♦ ♦ ♦ ..+ "♦ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes K No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> Have you'.alked with the township about your project and are they in agreement? c Yes f❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <br /> j 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) 1=1 yes No ❑Don't know <br /> 7. Is this to correct a violation? 0 Yes ❑No <br /> , Seo14-9- —17) --\Qac o‘Nti5 ' (1- I-411c <br /> � 't �C C <br /> 1 O 1 l '�n wS W a t 1- <br /> ka� APPLICATION SIGNED <br /> (Continue on Back) � ■ <br /> 545112(aloe) 30U r T��- CIA-12J2-1 <br /> - W <br /> hk W -♦ <br />