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SUPPLEMENT to Web•App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNA NAME <br /> !-"fi'a / .6 O(IG P' ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Str et,City,State,Zip) Deed Restriction; CSM <br /> a g6/ $ a5ston Rd d CC /eu9e 6✓0bi&j o r,535 7 Variance(# ) <br /> HOME PHONE CELL PHONE E- AIL ADDRESS <br /> • /, -•, 3 -3 S y��/-gy''7` 7 y,0 Ge. 1a,v7' ` pia: . Ca ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR 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 AIDDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) Li Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> 1.1 PARCEL �j-7 /� 1 73‘ frontage drawn to scale. <br /> NUMBER 11 /� � �%ZO20�� /�"' <br /> TOWNSHIP: if SECTIONI <br /> • S ,/: ,/,/: ❑ Driveway permits <br /> I ° 4 4 (state,county,town) <br /> ADDRESS: <br /> CSM: LOT SUBDIVISIO ❑ Sanitary permits <br /> a2(' (e,a 0 0//P/� BLOCK /LOT (public, private) <br /> PROPOSED PROJECT INFORMATION : , TA iIEvr <br /> PROJECT DESCRIPTION: / / £ g <br /> /Fe r,7o 'e r re (QCe. D6‹4 /4 X / P �. e ® i - -°� �--�b <br /> '_fir _'S, t i a '�' <br /> . ❑This project is a new building or structure. 1 o� �� <br /> This project is an addition/alteration to an existing building or structure. �r � <br /> i-a 4f , <br /> SANITARY SERVICE: ���{ PERMIT t\UMBER: � , },, �ta- <br /> SEWER `hC�SEPTIC new exh <br /> HEIGHT IN FEET ! _ NUMBER OF STORIES: (Not including basement) sa-'" :.4 . <br /> as sei opooain' <br /> bore ens'.attac•hr ent),Y <br /> AREA TO NEAREST SQUARE FOOT: � Z "�' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .. � �_; <br /> r-I-OS(�p&ofl o.p of <br /> BASEMENT 1ST FLOOR: , . <br /> �p �� // �, TOTAL SQUARE FOOTAGE: o 0 <br /> 2ND FLOOR: 3RD FLOOR: DD {- r r �t i �r� ,�� " , <br /> a s <br /> ESTIMATED CONSTRUCTION COST: : Q oat . <br /> (Please round to nearest dollar) "∎ "� --► 'F► -2)300 oG � , , 2.� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'No ❑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 pro erty in the past 5 years? ❑Yes ONo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) 1 ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —0 —► <br /> 545112(4/08) <br />