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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO P,.• IDE <br /> OW '- NAME .� A -1 <br /> ,n ^ ' �� <br /> O TA DRESS (N ber,Str t,City, tale,Zip) v Zoning Statu'; CUP; <br /> ` ' � ....3 i / Deed Variance Re(trict -• M <br /> � Variance # j , <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS / / r4v' <br /> cr°1 ' °I° % r41 Site Plan drawn to scale f <br /> AGENT INFORMATION CONTRACTOR INFORMATION and ir�IL�le�dimensions 5-O <br /> AGEN CONT CT NAM �S I'N� <br /> �� / Site Plan including locatio <br /> AGENT A■DRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) CR(setbacks 6 )/7° V <br /> PHONE PHONE --— Site Plan approval from //A <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale / / r <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 7 <br /> PARENT ?RCEL N MB C RREN ZONING: ACREAf� Elevation of property❑ PARCEL r,4 � y"`�6g0 r / 9> frontage drawn to scTOWN I ; ( CUUUJ SEC 10///���(JJ: ,/4 ( ,[[[ 1 ,// Driveway permi <br /> �� � L /4/4: /y (state,count own <br /> CSM: LOT SUBDIVISION �Bit7L�t OT Sanitary permits p..... , <br /> �y o (public, ► 0 <br /> PROPOSED PROJECT INFORMATION tiltiw REVl <br /> PROJE S yON: i a �-- �r <br /> aC 22 ,c /6, a1 4-d ‹c I- Sao ►, Zoning <br /> ❑This project is a new ilding or structure. S l Pe hied Use? ,4 . <br /> This project is an ition alteration to an existing building or structure. , <br /> SANITARY SERVICE: PERMIT NUMBER: 4 M o "' ' <br /> fSEWER SEPTIC ` ;' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 2 <br /> t' ,€ „ -«.,per <br /> ttafhm t) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: g <br /> � s ���{����� <br /> y4, TOTAL SQUARE FOOTAGE: 4, </ ya $c s � nce,r <br /> 2ND FLOOR: 3RD FLOOR: ����i� e?.°�. j; / <br /> ltoa a• tion$U <br /> ESTIMATED CONSTRUCTION COST: $ e O t per. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ /81696 , � 'f.; „ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Ye o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑ s No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan tf none) <br /> 6. Is a location survey required? (see reverse); ... ['Yes No ❑Don't know <br /> 7. Is this to correct a violation? U Yes ❑No <br /> s7O'f to APPLICATION MUST BE SIGNED <br /> (Continue on Back) -1 -► -∎ <br /> 545-112(4/08) <br />