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SUPPLEMENT to Web-App # <br /> ZONING ' ERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> TO, dt AWE ❑ Zoning Status;CUP; <br /> OWNER ADDRE' Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Zdva go. er -F 'rc i 544 Pte,)-,`e r Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Car 1 -e LS \ lep +1 +j')(,- ❑ Site Plan including location <br /> AGEN r ADDRES• CONTRACTOR ADDRESF of well/septic <br /> lajirlary) Pci <br /> (City,State,Zip) C�it ,�S'taatte,Zip) ,� ❑ Setbacks <br /> PHON <br /> PHONE Duty c/ ■ 6 l Site Plan royal from <br /> ❑ approval <br /> , to, (gQ 45-7 col e t applicable township. <br /> E-MAIL ADDRES' E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL �4� _3 _��-4_, 2-1 frontage drawn to scale. <br /> NUMBER J <br /> TOWNSHIP: . SECTION: <br /> G{Y C.(2, .1/4: ... .F7. 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> �- '' C C,VeS- C 1 VG(-S2, <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION 1 VII <br /> PROJECT DESC' ION: <br /> . ❑This prof: l is a new building or structure. o e1� s <br /> 2 This prof: 'is an addition/alteration to an existing building or structure. a <br /> �Aual� <br /> SANITARY SERVI A, /J PERMIT NUMBER:, / /� <br /> ER nSEPTIC /" /.7 /"/K '1 -° <br /> HEIGHT IN FEET:` t' NUMBER OF STORIES: (Not including basement) <br /> No C RAW 6 • FIfirOtar WI' OP Eit‘: irN6 ktwt 'a .,€,: ./ Iood ain/ <br /> AREA TO NEAREST SQUARE FOOT: B <br /> (Outside dime 'ns including unfinished area, attached garages and above grade decks or porches) o <br /> BASEMENT: 1ST FLOOR: '' ' > ,_iiii Z 3 e _,�,f1 Pay j TOTAL SQUARE FOOTAGE: 4, rSE � <br /> L s,d a, <br /> 2ND FLOOR: 3RD FLOOR: �(rt= a'css <br /> ,V 143 32 3F Co✓atz A <br /> e� Location Sury <br /> ESTIMATED I 0 STRUCTION COST: ♦ --► ♦ ♦ ♦ and available opt ;. <br /> (Please round to nearest dollar) t ,y <br /> 1. The prope y s within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a e'and or floodplain on or near the property? Yes r4 o ❑Don't know <br /> 3. Have you t:l '-d with the township about your project and are they in agreement? Yes ,„!! No <br /> 4. Has there •e:n a zoning permit issued for this property in the past 5 years? ❑Yes ■ No <br /> 5. Is this proj:ct associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a Iocatio -urvey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to c• r:ct a violation? oyes Olo <br /> )-'1A° <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -♦ <br /> 545-112(4/08) <br />