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ei;\ (1)10 SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.corn <br /> PROPERTY OWNER INFORMATION CUSTOMER TO.PROVIDE <br /> OWNER NAME Ci(1`G'�� I <br /> � s h� ❑ Zoning Status;CUP; <br /> OWNERAAI SS (Number,Street,City State,Zip) Deed Restriction; CSM <br /> 13 & Cc'r$ k ki a� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> �p0$-2 LS a (ap$-2 ZS-�2;al 1.,. • >, • at r s'I 14W. ❑ Site Pla d err 1e�scale <br /> AGENT INFORMATION CGHTRACTUR INFORMATION and inc s R Sions <br /> AGENT NAME CONTRACTOR NAME <br /> j la'j'‘ ❑ Site klanp5luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of we ptic <br /> 93i6-ivVs 1414 Rd <br /> (City,State,Zip) (City,State,Zip ❑ Setbacks 1 G/S( -(2 <br /> ni et-c kc 5 -t• S 3S/ r (�(?,;tV� <br /> PHONE PHONE ❑ Site Ic�1 a al TrOm <br /> &O —Zi Z.- 2_( 0 0 applic�bl hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • 'Idivso.PbbicALEA I-NT— �EnM;I ❑ Floor p �le <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevatio of r y <br /> PARENT PARCEL NUMBER: p-lac).— CURRENT ZONING: ACREAGE: <br /> NUMBER pd� Iy3-10 eH-3 ci fronta o Cale. <br /> TOWNSHIP: SECTION: ❑ ( V <br /> Tad C{' nIA20w►a,AJ_ 1 y 1/4: .�/ 1/41/4: _E Drivew <br /> ADDRESS: (state, y,town) <br /> �� �r�C �-c� ❑ San.:: ,-r , - --�/, 11j <br /> CSM: LOT SUBDIVISION BLOCK/LOT vU <br /> a. 3 O c,� (pu li r at- <br /> ." <br /> PROJECT DESCRIPTION: t <br /> k�A 4t G 1l� a ti , <br /> This project is a new building or structure. IJ 5e <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 <br /> h <br /> nSEWER 'SEPTIC a { � <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not including basement) ,%f\--\e \ ` Sho ( . men,#t/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensiol including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> .' 0 4, TOTAL SQUARE FOOTAGE: *disturba ce <br /> 2ND FLOOR: 3RD FLOOR: 'J7��/ras/�(00 p� <br /> ESTIMATED CONSTRUCTION COST: d :,.':7r°,;:''',i,a s• ,; <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �i p C O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ig -s ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? jil es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? (jam Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? `!j 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) Eyes In.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes /g.blo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -♦ <br /> 545-112(4/08) <br />