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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW ER NAME t 0 ,, t <br /> G. \M V - �1 Yl r G Eoning Status; CUP; <br /> OWNERADDRESS (Numb Street,City,Stat ,Zip) I,, Deed Restriction; CSM <br /> y 7 S S 0.l l�V`V("�� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRE S _ <br /> .p$—,S S ( -6'7 7 r 'QS 1 ADDRES <br /> 1 , L t � ,) , 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) 1=1 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: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER o s-o 4 —0 9a- yqyy ti I CEO ail=(', frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> l r��o 0 .�°: .41/4' ❑ (state,county,town) <br /> ADDRESS: 1 j <br /> 3 7 r-∎S r,. Om h- y e a7-®r�-�J,ON 33"7 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION U BLOC <br /> + (public,private) <br /> PROPOSED PROJECT INFORMATION �? � <br /> PROJECT DESCRIPTION: <br /> • El This proj act is a new building or structure. ��tted Use? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERV CE: PERMIT NUMBER: 0 Rut "'' <br /> / a <br /> nSEWER SEPTIC 1 ; ° , F 1,4 , <br /> � ' <br /> HEIGHT IN FEET J NUMBER OF STORIES: (Not including basement) <br /> / `I t d ► tirt <br /> e-l'tor s (a ) <br /> AREA TO NEAREST SQUARE FOOT: ce" <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ' <br /> BASEMENT: 1ST FLOOR: ) t � <br /> I W �J S ..--- j TOTAL SQUARE FOOTAGE: 4 - , i n s' <br /> l O fit 4 + <br /> 2ND FLOOR: 3RD FLOOR: I ^ n/ <br /> ��/ �0/ ► � w <br /> ( ♦ ♦ ♦ ♦ ♦ Limon Si <br /> ESTIMse ATroEuD nc CtC d NSTRUCTION COST: ♦ $ 17 (/6) availa� j <br /> s <br /> nearest dollar) <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? ❑Yes �No ❑Don't know <br /> 3. Have you calked with the township about your project and are they in agreement? ❑Yes El No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan I none) <br /> 6. Is a location survey required? (see reverse) ❑Yes !4 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes IS o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► <br /> 545112(4/08) <br />