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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 SS L <br /> SG.lie (ior-p. ' CU&CI tit, t^-.1 V k(itt�(c. ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> l06 1V- cSt,ot ett- RQ�I MMxtGbt,el (A)T. S3 C4 ° Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRESS __II <br /> ,6;- ' I.Y 1 :•8- - S •Gimme �f td-net` Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> To Am Neer Site Plan including location <br /> AGENT ADDRESS CONTRACTOEkDDRESS a of well/septic <br /> 2 ( 2 S l3&d�,w- off. <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Aft a-etCS*r .53703 <br /> PHONE PHONE ' Site Plan approval from <br /> 6 D g. a b S_' ` (0$ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> alter )k Ver dt ‘ [Viloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us,i <br /> PARENT PARCE NUMBER: CURRENT ZONING: ACREAGE: 11.2/Elevation of property <br /> ®PARCEL Q o j . ,I 75- frontage drawn to scale. <br /> NUMBER �� t�gO�p-3L1.SagS S� R •1 Z `1- <br /> TOWNSHIP: SECTION: <br /> M a-t o )anti 1/e: '/a'/a: Driveway permits <br /> e (state,county,town) <br /> ADDRESS: �Q J <br /> (e b (2 s Ouw" `d Sanitary s- • ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> public, •rivate) <br /> PROPOSED PROJECT INFORMATION ') <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> g '(�of a dole;{ -to �er • M (v' 1-t 4bo.x cl t-t- ❑ Zoning District <br /> . ❑This project is a new building or structure. © Permitted Use? <br /> 121This project is an addition/alteration to an existing building or structure. �`= <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> EWER iEPTIC (new/existing) <br /> © Wetlan <br /> HEIGHT IN FEET: s NUMBER OF STORIES: (Not including basement) , <br /> d/ toodpint <br /> AREA TO NEAREST SQUARE FOOT: Shorelartcat#achment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 0" ErosionControl permit <br /> BASEMENT: eta 11.4,A e 1ST FLOOR: <br /> (� �7 rC ✓-%/. 7 . (Slopes distubance, <br /> filling/access) <br /> 2.49-FL-OAR: pe e'l„4, 3RD FLOOR: <br /> 2 4S-S F (0 [3 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 7o DOd and ava>aillable options. <br /> (Please round to nearest dollar) 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes RNo ❑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 ❑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 /> ‘t aqV v APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 301 (Continue on Back) <br /> ft( V <br />