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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU .TOMER TO PROVIDE <br /> OWNER NAME 2 <br /> l,�n � ^ /. <br /> OWNER ADDRESS (Number,Street,City,State,Zip ` Zgning Status;CUP; <br /> �j V Deed Restriction; CSM <br /> c� �S� l J/�s)bc,fn svr �fa;f, f, i1J ] 535 / }Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILA'DRESS <br /> (,O� �q y-'� p f i (,{ 77OU mu;�,GOm Ite Plan drawn to scale <br /> AGENT INFORMATION CONTIRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CO NT- TOR NAME <br /> C)(�1n,-,✓ /1(,J h�� S' a Plan including location <br /> AGENT ADDRESS <br /> CONT.' TORADDRESS well/septic <br /> (city,State,Zip) (City,Sta r,Zip) Setbacks <br /> PHONE PHONE ❑ e Plan.approval from <br /> Apple township. <br /> E-MAIL ADDRESS E-MAIL A.D RESS <br /> Fidor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of Property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> '� frontage drawn to`scale. <br /> ❑ NUMBER ����dVp7-�GOv�3 1 5, p� <br /> TOWNSHIP: SEC,10 ,/4 A , ❑ Drivewq�rperm Al <br /> ki ADDRESS: (state,count�,iown) <br /> o�FS�// (/�n Urn �� ❑ sanitary <br /> permits <br /> CSM: LOT / SUBDIVI'.ION BLOCK/LOT u )1 nvate <br /> UG�S� (Pf)� ;P � ) <br /> PROPOSED PROJECT INFORMATION or Rol y <br /> PROJECT DESCRIPTION: �O 1 ' � ��� s <br /> . ❑This project is a new building or structure. i <br /> Egi This project is an addition/alteration to an existin• building or structure. <br /> SANITARY SERVICE: PERMIT UMBER: al` •rem <br /> SEWER SEPTIC <br /> HEIGHT IN FEET: , NUMBE-•OF STORIES: (Not including basement) f <br /> /5 ,'Wetland ..pdin/ <br /> ,Ss0 a ( � '-tit) <br /> AREA TO NEAREST SQU'RE FOOT: jf <br /> (Outside dimensions including unfinished area, attached g.rages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: %/,,; <br /> 70/0 4, TOTAL SQUARE FOOTAGE: 4, � ' • <br /> 2ND FLOOR: 3RD FLOOR: <br /> lad <br /> a aw !s .Sure f <br /> ESTIMATED CONSTRUCTION COST: any _� , ; <br /> (Please round to nearest dollar) '♦ '♦ ♦ ♦ --► $ 4,75) 000 i <br /> 1. The property is within 300 feet of a stream or 1 feet from a pond or lake? Eyes [No El Don, know <br /> 2. Is there a wetland or floodplain on or near the pro�,erty? <br /> Eyes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? oyes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 yeas? ..;.. Yes ❑No <br /> 5. Is this project associated with arezone/CUP/varia ce(petition/appeal 3i �) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑YesNo ❑Don't know <br /> 7. Is this to correct a violation? <br /> Dyes <br /> No <br /> �� APPLICATION MUST BE SIGNED <br /> �. C (Continue on Back) ♦ -� —► <br /> 545-112(4/08) <br />