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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 /> Tex �'Vl4 v�jvi ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> HOME P N� I ) CCELL t'1. te Rd E-MAIL ADDRESS Variance(# ) <br /> 83 ' Ss-? ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> --A;—„,, L4 4. ,s.vi ,./14,1c,,,(4„., (, ,-ciA c ai, kicyc ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR DDR SS of well/septic <br /> f-Z JIt C177 eepA t'SY I J• S?c- h€r 2. <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> ' ap s , I 1 (O 0 2 z(„, c. .:(—.... applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> w 4. <br /> PROPERTI/LOLAT:ON INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> /; / frontage drawn to scale. <br /> NUMBER ���� �+�( 7� �C7� �a l� �� !� g <br /> TOWNSHIP: SECTION: <br /> ,/. ,/4,/. ❑ Driveway permits <br /> 7/14,t k" 1. (state,county,town) <br /> ADDRE S: �{ <br /> 3 �� /�� <br /> 1 r J C1; Y ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ".., ,Z,TAO " 5 . <br /> PROJECT SCRIPTION: / , <br /> This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. x <br /> SANITARY SERVICE: PERMIT NUMBER: 0° r <br /> F1SEWER "SEPTIC <br /> "r z <br /> _ .Y - <br /> HEIGHT N i, /4:: . NUMBER OF STORIES: (Not including basement) � e z�mrW 1 <br /> ;n SI� -11:ii 1"I]s1 <br /> AREA TO NEAREST SQUARE FOOT: • , a ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .� a rJ,. :::: , x : <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: j r& r «t"`,. . ?� <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: ! .^ t-i4/r ao aye :; <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 ZNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes 1No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes ❑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 ISI No ❑Don't know <br /> 7. Is this to correct a violation? Eyes g.No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ .-■ - <br /> 545-112(4ro8) <br />