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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 /> F-'n'1a1�C.1 S 0L.LI G ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,Stat Zip) <br /> a r� n rr Deed Restriction; CSM <br /> 11 V I I O R 'T`) lam• I3 (- Variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> g4'5-7 ( -2-O '4'4 -1 ci 2 Z • e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd inclu s dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Si Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septi <br /> (City,State,Zip) (City,State,Zip) ) Se acks, <br /> PHONE PHONE / 1 ite PI pproval from <br /> app"cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or pla s to scale <br /> PROPERTY/LOCATION INFORMATION `(http://accessdane.co.dane.wi.us/) E ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> El PARCEL l I rontage drawn to scale. <br /> , <br /> NUMBER C 0 I I QOp I C 0 — I . ` <br /> TOWNSHIP: SECTION: <br /> p a` K G D L e 1/4: ,/1/4: El Drive ay pe its <br /> ADDRESS: (state nty,town) <br /> v 7g -7 2 Co(rJ--; LR ,Dr <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> ��` S �r (public, private) 1 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW Ni, <br /> P ECT DESCRIPTION: /` <br /> Kes Jrc->t,-.sc G A(ZPr/; - 3�x,ejc) ;Zoning District <br /> . [ .This project is a new building or structure. Permitted Use? <br /> n This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: -v Rur l ddless <br /> SEWER SEPTIC )\f —r (nev existing r. <br /> HEIGHT IN FEET: NUMBER OF STORIES: Not including basement) <br /> I <br /> Wetlar�d(Flo+ plain/ <br /> Shorela .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: ErOSi nCon permit <br /> (DC) j TOTAL SQUARE FOOTAGE: 4, _(slopes s sturbance, <br /> 'fill ) <br /> 2ND FLOOR: 3RD FLOOR: , )�^O <br /> 'Peview Location Survey <br /> ESTIMATED CONSTRUCTION COST: and vailable options. <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? 0Yes giNo 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? fYeslo El Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? SYes n No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElYes ®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) Eyes n No ❑Don't know <br /> 7. Is this to correct a violation? iii Yes n No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0 -* —0 <br /> 545-112(4/08) <br />