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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNNEERNAME <br /> 1 '^'i �syC Zoning Status; CUP; <br /> OWNER ADDRESS (Nu ber,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 3(03(o R. ,t„t•y.1 -b,-)"1 t.) 7 L 2 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (00? Sal 78cb .- 1 M Ca a e wlCLA ! , <<"- EKte Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o 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 ADDRESS <br /> 1:Sloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> El UM <br /> NUMBER ®(pit 35388 3t► Al- Ex Co. 9 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1-- u ,., a 1/4: %1/4. Driveway permits <br /> ADDRESS: n T ( 1 v q (state,county,town) <br /> A J zi R. r -fr-N_D -PO•J 1 L 2°n-D / SG J`1 i'L'YL..j �-1 1 j�J 5 6 1 <br /> \Eq.CSM: LOT SUBDIVISION BLOCK/LOT Sanitary •- <br /> (public, erivate) <br /> PROPOSED PROJECT INFORMATION ,F <br /> PRO T DESCRIPTION: <br /> . gThis project is a new building or structure. Q Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. 74 P.',==',,, %": <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> .� <br /> F1SEWER SEPTIC %* <br /> d"It3 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ,;'- <br /> 14 -, . Pte,. <br /> s, # '' <br /> AREA TO NEAREST SQUARE FOOT: �, 1 � , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I;rmm?rmt3 fllrimt <br /> O ( 4, TOTAL SQUARE FOOTAGE: ,, sea #I' 1r)rnce ' <br /> 2ND FLOOR: 3RD FLOOR: <br /> ) 781 .0 4 7 motion Ste <br /> ESTIMATED CONSTRUCTION COST ba and available <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ 3 o ba "' iF1� . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> El <br /> 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 property in the past 5 years? ❑Yes 121/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 2. 10 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 ■ - <br /> 545-112(4/08) <br />