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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NWE <br /> 1-tci-al 'C anc 2r- ' A. Yloy.ec ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 101 ct . ff SGlwoA 'gotta t &P' k t�T S 3369 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL DRESS <br /> \ I A 'too3-V1211 yI .f'(o cf@ r ers,nc re-A-- ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> —Se4c.e. D <br /> D. '(Y(oY-c.0 Coon. Ne-\sor CruN1 -c-toy. El site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> as c`b -u<. 1411 K', - s L1 <br /> (City,State,Zip) (City,State,Zip) 1 , q ❑Setbacks <br /> ■■ �� S}o��h W S3Ve 1 <br /> PHONE `t PHONE ❑Site Plan approval from �. <br /> tk C0o8_s I(o _31i SS— applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> U. tt Floor plans to scale <br /> C{new,n ll�,¢yahoo•Co t: ,nn. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL _Z p0 frontage drawn to scale. <br /> NUMBER tcio 'i132-N " --3 RN <br /> TOWNSHIP: SECTION: <br /> R∎A\and \(W %: NVJ %oh:-Ts N ❑Driveway permits vi <br /> ADDRESS: (state,county,town) <br /> 109-c► Smarr Sc,�o\ qx,c , S\;:t��.\AA.Y. ()S 5358 <br /> CSM: LOT 3 SUBDIVISION BLOCK/LOT ❑Sanitary permits NI A <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Dry Sior&32 j Co\cj pa\,L S fv{olt t)(6,3 ❑ Zoning District <br /> . " his project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER r)EPTIC NIA A (new/existing) <br /> HEIGHT IN FEET: , 111 NUMBER OF STORIES: (Not including basement) <br /> a ip ` ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1—i ErosionControl permit <br /> N IA ] `C a 4 <br /> _- . 4 TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: `n J 1 filling/access) <br /> N I A Nil A a I S a� .4 , ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -► 00 and available options. <br /> (Please round to nearest dollar) �J 1 S�- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes DC ODon'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? Oes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EKs Olo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Elves �I ['Don't know <br /> 7. Is this to correct a violation? [-Ns <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► —► <br /> 545-112(4/08) <br />