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1 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU :TOMER TO PROVIDE <br /> OWNER NAME <br /> F0. rIG\ IAot , Jesse i4eLS+ la Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 313 R g,-ti, <e , 131oo VA Ir19 �0 V ,Wj 5371'1 variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> 907-311 $?7 6d4•Zi5-cos 4) a Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ ite Plan i ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we eptic <br /> (City,State,Zip) (City,Stag,Zip) Setbacks <br /> PHONE PHONE ❑ ite Plan ap val from <br /> pplicab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevati of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> ❑ NUMBER 0, `0- oSr'2970-1 ^ jolq fron ge drawn o scale. <br /> ^` ` % <br /> TOWNSHIP: SECT ,,1 <br /> E V 0° ms G Pave,, 1/4: /V (.1: ,/4,A4. ❑ Drivew permits <br /> ADDRESS: (sta ,county,town) <br /> 313 P.zkt. . <br /> CSM: R.4_eft, +n LOT s SUBDIVISION BLOCK/LOT El Sa ' ry permits <br /> CAIN kar el I ( �lic,private) <br /> PROPOSED PROJECT INFORMATION $ `/U= ,,W <br /> PROJECT__DESk CRIPTION: 7 !3 ; ; �: <br /> • ❑This project is a new building or structure. " <br /> nil This project is an addition/alteration to an existing building or structure. <br /> .L,(4-SANITARY SERVICE: PERMIT NUMBER: } <br /> SEWER nSEPTIC —' I <br /> HEIGHT IN FEE-E NUMBER OF STORI?S: (Not including basement) A 444 <br /> 534 I �.: a e�«:,r^iI r 4010 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached gauges and above grade decks or porches) <br /> �" <br /> BASEMENT: 1ST FLOOR: `S <br /> j TOTAL SQUARE FOOTAG E: j + + + { 7 w <br /> 2ND FLOOR: 3RD FLOOR: I` � � <br /> ESTIMATED CONSTRUCTION COST: Q d6 , , a• <br /> (Please round to nearest dollar) ♦ '♦ ♦ ♦ ♦ $ f �� „n s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No MI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No IX 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? IA 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 /> Life* ,o°�s3�'3,a SS5117 - 53, APPLICATION MUST BE SIGNED <br /> �I <br /> I ?e (Continue on Back) <br /> 545-112(4/08) —. —� <br />