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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWR NA IV <br /> P <br /> G �',�I C /ve oning Status; CU �y°( <br /> OWNER ADDRESS (Number Strea t,City,State,Zia <br /> b (( V C"l U J Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AEDRESS <br /> 3� $ Z Site P drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S an including location <br /> AGENTADDRE _ CONTRA T•' I.'DRESS of well/septic <br /> (City,State,Zip) (City,Stat ,Zip) tbacks <br /> PHONE PHO , Li Site P proval from <br /> app• le nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elev • of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑ PARCEL (� / outage drawn to scale. <br /> NUMBER oS 07'93 c '�3p n R <br /> TOWNSH P: SECTION: <br /> ,/: S ,/4,/: Drive ermits <br /> �:f `f,.� 5 (stat o ty,town) <br /> ADDRE J <br /> C�( ( �=-` Sanita s D <br /> CSM: LOT SUBDIVISION BLOCK/LOT _ (publ.Kprivate) % v <br /> Ss� II <br /> 4:..,_ <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: P <br /> 4.re.s.<-. l't X Q CS <br /> f_`4%1.- oning District <br /> WO <br /> n This project is a new building or structure. (V] ermitted Use? <br /> n This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU R: A al L• - S <br /> nSEWER iP7SEPTIC (ne existin• <br /> HEIGHT IN FEET: NUMBER OF S RIES: (Not including basement) <br /> 4 <br /> iJ� // ❑ Wetlan to plain/ <br /> ( hor ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1STFL0Q 7-, Erosio ontrol permit <br /> I ^ j TOTAL SQUARE FOOTAGE: 4, (slo es,dl rbance, <br /> 2ND FLOOR: 3RD FLOOR: `� fills g/ CCeSS <br /> ) eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -+ —I. -0. --► ♦ $ i Q ►\ and available options. , <br /> (Please round to nearest dollar) L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the pro•erty? El Yes No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .... Yes No <br /> 4. Has there been a zoning permit issued for this pro•erty in the past 5 years? ['Yes No <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal#/(1F 9' ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes -1S'No [1 Don't know <br /> 7. Is this to correct a violation? 0Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ♦ -♦ <br /> 545-112(4/08) <br />