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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 /> NA t\-Notr, or"k 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Numtter,Stmt,City,State,Zip) Deed Restriction;CSM <br /> • a( 1 Cun}1 tdr k..".1 -"SCt t, Vclreb., S' ' 3'c-'? Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 77O-7t5-2'5c. 513-.4.'-i 4- -z-w4-z -5i.-\. rtnru)ft-No we r �1 •''O Fite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> As L .4.4,Ire c-lr .rsr tc-A c j +r Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> t2I.7 C vl cn `2 StiArt -z ; <br /> (City,State.Zip) (City.State.Zip) [❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> C. C.)% - ..31g*-1 51‘i applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:itaccessdane.co.dane.wLust) [Elevation of property <br /> PARENT PARCEL NUMBER; CURRENT ZONING: ACREAGE p P y <br /> ElPARCEL frontage drawn to scale. <br /> NUMBER 0766-'& a -c% 00"S A--1 ( "4) Li <br /> TOWNSHIP: SECTION. <br /> Vcr,.1 t ' S 'l.: ' G '/,Y4: `.5 ❑Driveway permits <br /> ADDRESS <br /> (state,county,town) <br /> ";?L Ce" Coon} FA v911,1,.1c,.y Ca Pi}, 1stw-e. s1 Ws -s s7 7.--.. <br /> ❑Sanitary permits <br /> cSM LOT SUBDIVISION BLOCK/LOT (public,private) <br /> tsS.../P,c, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> '(mi l-5 t o,-.f 6'.A, , , 0 Zoning District <br /> . QThis project is a new building or structure. <br /> Permitted Use? <br /> Ef This project is an addition/alteration to an existing building or structure. rr� <br /> SANITARY SERVICE: PERMIT NUMBER: 4 Rural Address <br /> EWER EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0,Wetland/pl plain/ <br /> AREA TO NEAREST SQUARE FOOT C:.).rgG-W?'co m h�eland (attachment) <br /> (Outside dimensions including unfinished area,a = ed garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR �/(j Er0SionControtpermit <br /> A/11 Z I l [ i TOTAL SQUARE FOOTAGE: 1, (s s,diurbance, <br /> �4 fiiltlartg! ICCess) <br /> +/�, <br /> 2ND FLO C: 3RD FLOOR: :►ihit <br /> I Coca 2.3 i civ r'` ' `�1--.r -0 t ' <br /> 6 Reviir"t.tItitjn Survey <br /> ESTIMATED NST TION COST and available options. <br /> / (Please round to rest dollar) -► "I' "i' ♦ ♦ $ 110 2.11 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake'? ........... [-Yes 'lo [Don't know <br /> 1.� <br /> ff __ <br /> Is there a wetland or floodplain on or near the property? [Wes jlo DDon't know <br /> `'1. Have you talked with the township about your project and are they in agreement? .... Dyes LJ o Z'' ^***A . <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es o b * }"�` <br /> 4 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) QYes go QDon't know <br /> _nn�� 7. Is this to correct a violation? []Yes o <br /> Vr <br /> 7Ir'Nati:. Wt 8�„1,-, k o o'rKe APPLICATION MUST BE SIGNED <br /> �c "`t 6's c..S "lc ti ( 070 Co -3 c 5000 (Continue on Back) -a, --i. -► <br /> 545./12(tea r <br /> Tktfip Ana 1 7C (# - rj.3-Pi S -? �) tAl\'-,:C'' Fv .I 1(, . ( t� eb. .,c 1w51rc.4 (�'°' t <br />