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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 /> -6/1 ?A4 4 .K`( ❑Zoning Status; CUP; <br /> W <br /> ONER A DRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3lS• 104.G/DD ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR AME �// <br /> ALr :Sii6t/ /'[u"fa i t-16 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2M C rr 4 /fir/ <br /> (City,State,Zip) (Cil State,Zip) ❑Setbacks <br /> em.m •,aG 1 bit S-s}// <br /> PHONE PHONE ❑Site Plan approval from <br /> (9(.S.l/2 _03& applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> itos ;Lt 1��1C.1•C°7 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL�NUMBER: <br /> c / CURRENT ZONING: ACREAGE: <br /> ❑PNAURMCBEELR OS 4/OJb0 VSti S-V 12,14-' �.`1-5(t frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> C9 ,.i,44 ,fC1,k) '/e: 1/.y: ❑Driveway permits <br /> ADDRESS: / Pluffil (state, county,town) <br /> (�0� 0 n �O"tat get ❑Sanitary permits <br /> CSM: LOT SJJBDIVISION BLOCK/LOT (public, private) <br /> S NAVIDW I�oiiS <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: f f■rStr/7t4L Le 1,7,—t.-i Orl £7 '/ )/ <br /> ❑ Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER IREPTIC 1 3 -20/..c- OO 2.31 (new/existing) <br /> HEIGHT IN FEET: � NUMBER OF STORIES: (Not induding basement) <br /> 1 5 ode ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT. / 1ST ❑ ErosionCOntrolpermit <br /> 118`k *iffy 34'}I, ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> SyG3 <br /> ❑ Review Location Survey <br /> ESTIMATED ED CONSTRUCTION COST: ♦ ♦ --► -iii. --I. �4d,0� and available 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? [Yes EIVo [ Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ales No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IXINo <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 pi o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes P' o <br /> / 0 (..9 8Z— <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i - <br /> 545-112(4/08) <br />