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U <br /> 1 <br /> , . <br /> �� SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION .countyofdane.com pp <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME \ <br /> r <br /> ba v0. -��-J 0.v\i A e. v0`S4 ❑Zoning Status; CUP; <br /> OWNE ADDRESS (Number, eet,City,State,Zip) I Deed RStatus; <br /> S 13 vim '�. Qom` feS4'I 4�y' 535-3.Z Variance(# ) <br /> HOME PHONE CELL PHONE EtIAIL ADD;RESS <br /> -'b y6 -4.7o GO%-3S` K� cKIGS 1- ` t.,.X.c..)v-rv. tat .P1.4.);.'47‘ ❑Site Plan d(�to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include dimensions <br /> AGENT NAME Ep r CONTRACTOR NAME <br /> J�Q4'I I In t� 51-00€_ 1J c.,\(1 tA5 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS It Wen/septic <br /> ) ci3 ( 4).1 �v.e_ av$ cryL <br /> (City,State,Zip) (City,State, ip) e-3 S 7 ❑Setb s <br /> PHONE T P ONE ❑Site Ply' a•.r r m <br /> 9©D 7 1 2 �3 5--)-10 applic. .1- ns ip. <br /> E-MAIL ADDRESS E-MAILADI- 1 <br /> J - ; �''P`>-5 . ., Floor plat scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT.ONING: ACREAGE: ❑Elevations,of• u,,-rty <br /> ❑PARCEL frontage a : r o Cale. <br /> NUMBER <br /> TOWNS IP: SECTION: <br /> its <br /> J t e v _\✓\o- 1/4: 1/41/4: El Drive y <br /> ADDRESS: <br /> (state c ty, own) <br /> D (� <br /> 65 1 3 a YsZ44re S1(�-t)J 5` 7 52. <br /> El Sq.,nit ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pbli ,private) <br /> wv' �,r P n<- <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DES RIPTION: <br /> �� Cp es'A'j D0 ❑ Zonin strict <br /> . ❑This project is a new building or structure. <br /> ❑ Permitipd l se? <br /> [phis project is an addition/alteration to an existing lbuilding or structure. <br /> SANITARY SERVI E: PERMIT NUMBER: ❑ Rural A.. s <br /> EWER EPTIC L (new/e <br /> OL <br /> HEIGHT IN FEET: NUMBER STORIES: (Not including basement) ❑ Wet! / <br /> Shot a chment) <br /> AREA TO NEA 40UA-L F•s <br /> (Outside dimensions including unfinished area ed gar- no a.ove grade decks or porches) <br /> BASEMENT: 1ST FLOOR: L ❑ IC., �OI .ermit <br /> 7 N j TOT �"' E FOOTAGE: j (slot- d a . •ante, <br /> \\\ i� �, fillip./access) <br /> 2ND FLOOR: 3RD FLOOR: r-, t 1 <br /> 'I\ Revie . .t' Survey <br /> ESTIMATED CONSTRUCTION COST Q and ay. a spti . )n/k' <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ � ♦ W 62 Dc. O lip <br /> . <br /> 1. The property is within 300 feet of a stream or 1000 fleet from a pond or lake? [Yes Vo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement? :Yes 51 o <br /> 4. Has there been a zoning permit issued for this prop rty in the past 5 years? ❑Yes o <br /> 5. Is this project associated with a rezone/CUP/varian (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) es : ': ODon't know <br /> 7. Is this to correct a violation? ❑Yes r; o <br /> , <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -♦ -4. <br /> 545-112(4/08) <br />