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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATIOON� CUSTOMER TO PROVIDE <br /> OWNER NiE4 ei'wv� <br /> FA Zoning Status; CUP; /' — ' <br /> OWNER ADDRESS (N tuber,Street,City,State,Zip) <br /> 1`� S � Deed Restriction; CSM <br /> HOME PHONE 5 $CLL 1 0TO U��;�� E-MAIL L A DRESS Variance(# ) <br /> y�/5-o°�/°� la Site Plan ra to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimension ' /}� <br /> AGENT NAME / CONT CT��R NAME (%V <br /> , /� do/ ti-14— �fGa //�C 'Lill Site Pla in ding location, <br /> AG NT ADDRESS CONTRACTOR ADDRESS of well/se tic t. <br /> (City,State,Zip) (City,State,Zip) ItX I Se cks �� <br /> (J�./� f �" / <br /> PHONE PHONE t� Site PI n r val from �� <br /> , .(0—G CS U applicaF �n iship. <br /> E-MAIL ADDRESS <br /> i <br /> E-MAIL ADDRESS t Floor plans#ale # <br /> ce <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �� Elevation of r eft <br /> PARENT PA,,RR[CELNUMBER: CURRENTZONING: ACRE.A�GE: p y <br /> ❑ NUMBER �`��G7-°�,3���/U A -/ 3�- �i/S frontage d n to scale. <br /> TOWNSHIP: SECa?— / , 5 (_ / 1/4.1/4: <br /> A I�� Driveway perm' - <br /> 5 Pry r4: w /V <br /> (state,count to <br /> ADDRESS: <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Sanitary •- a.' / <br /> 3 9 3 I c�. -en.1 (public p ate) v <br /> PROPOSED PROJECT INFORMATION S" 1 ) !' <br /> PROJECT DESCRIPTION: (174:7w....$4_ <br /> This project is a new building or structure. ��® � A, ` N <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: — PERMIT.UMBER iaa <br /> ■SEWER ` PTIC �" / 5.... D D / .., <br /> .., ii , , <br /> HEIGHT I F T• k...4 NUMBER OF STORIES: (Not including basement) t�, /� / n , s a.pail <br /> ' AREA TO NEAREST SQUARE FOOT: of t <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porch <br /> BASEM NT: 1 ST F � ; ,: <br /> ` TOTAL SQUARE FOOTAG <br /> 2ND�L�Q�:� 3RD FLOOR: .-�i��6 - <br /> �:JJ — ittit <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 3�. e� , , ,1 a, <br /> (Please round to nearest dollar) a v.A <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Et ❑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 []'Yes ©No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes E o <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) ❑Yes ❑No ['Don't know <br /> 7. Is this to correct�;,- :.n. ❑Yes f 1Vo <br /> 8'7,, ! ) AT BE SIGNED- <br /> (Continue PPLICATION on BackMUS) ♦ ♦ * <br /> 545-112(4/08) <br />