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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 /> Marv, .- Suk A .qa��e 4-'1 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,ZiP) Deed Restriction; CSM <br /> D-1 so CT H Sjp� U T S 3 S �9 Variance(# ) <br /> HOME PHONE CELL PHONE '4 -MAIL ADDRESS <br /> &LT- . -5535- (cog-�9a- �$-�� ('at,v, r S In lb"h" '" tI • (°"h ❑ Site Plan drawn to scale <br /> AGENT INFORMATION � CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.daACREAne.wiGE:.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: <br /> ❑ PARCEL /7 frontage drawn to scale. <br /> NUMBER UCD t I - a' - q i- .- R 1 0 5- <br /> T NSHIP: SECTION: <br /> �1 ❑ Driveway permits S f'1 S 21 '/: 1/4:/ (state,county,town) <br /> n)ADDRES <br /> 1 l 7° e-�� El AL <br /> Sanitary permits <br /> as— <br /> N <br /> CSM:3 b LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION y <br /> PROJEE T DESCRIPTION: ff' i , ,' ` y <br /> Kevin Due Oe \C, - AAA 43 Sc�Sas r r oo rr� 13 wing i , . <br /> E <br /> . ❑This project is a new building or structure': <br /> XI This project is an addition/alteration to an existing building or structure. �1 <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> f SEWER SEPTIC new xi <br /> v <br /> HEIGHT IN FEET:/6 NUMBER OF STORIES: (Not including basement) <br /> / El es a ....1 <br /> S ' did. r�. Wit) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> Eros' <br /> BASEMENT 1ST FLOOR:,210 V 1b <br /> 4, TOTAL SQUARE FOOTAGE: � ++ r 5�� ��C� , <br /> �, cis) <br /> 2ND FLOOR: 3RD FLOOR: Y H u <br /> y0� <br /> C 0z " �ey <br /> ESTIMATED CONSTRUCTION COST: $ //I 0Q 0 V 13 ., ,, Sala <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ D <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes Ki No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NlYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®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) ['Yes No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -+ <br /> 545-112(4/08) <br />