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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> Li''r VP( 1-1) <br /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Cy,,State,State,Zip) <br /> 4 La,a�. Senn (J 7 �j S /�c�a r'�,n �/ S�;S Deed Restriction; CSM <br /> 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Clif - 5--12c.1°, .605.--,,3 5-45.D.0 <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> `mac,y 51)y"►@" ❑ Site Plan including location <br /> AGENT ADDRESS 4ONTRACTOR ADDRESS of well/septic <br /> (f.a-a4- Senn eth 51- On( <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> Gjg_ r63g-/c. q c applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER oG to - 1"] 't-c-353-0 p 1 O,34.2- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> E L N6/ .1/4: .1/41: ❑ Driveway permits <br /> ADDRESS: L / (state,county,town) <br /> q-Qa(t 5610/1 01 A f" ric F.7^/.,�'.) v17, - s g ❑ Sanitary permits <br /> CSM: LOT 3 lM p Q SUBDIVISION S BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW F <br /> PROJECT DESCRIPTION: xA P; - `" , '��s:�' <br /> 6.1 (f. s� ri, stool ®gym a n t 4 _ <br /> . IS This project is a new building or structure. o 1 <br /> ❑This project is an addition/alteration to an existing building or structure. -- y <br /> SANITARY SERVICE: PERMIT NUMBER: R s m m '" <br /> 0 0,-T' <br /> hew exsfi g.'" <br /> SEWER nSEPTIC �, w "�1 <br /> HEIGHT IN FEET: l NUMBER OF STORIES: (Not including basement) `�-" ',' <br /> ® • d® aW.. <br /> \ �� I Z ore aria'a chnient) <br /> AREA TO NEAREST SQUARE FOOT: „ �*" t. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) R s _ <br /> r <br /> BASEMENT: 1ST FL O�4 L � t ®e , ei eem Ac ', l°j, TOTAL SQUARE FOOTAGE: j <br /> 2ND FLOOR: 3RD FLOOR: V f - C� m € <br /> s "idalLT m - <br /> ESTIMATED CONSTRUCTION COST: '` - o7 'S -1---.. m �� <br /> (Please round to nearest dollar) ;, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes C]No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Eyes JNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ef No <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) El Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ElNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ --► <br /> 545-112(4/08) <br />