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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 /> M IC OA eL )'7 41 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> &921/ --1-1:1/ ) Deed Restriction; CSM <br /> � ti �� Variance(# _ ) <br /> HOME PHONE _ CELL PHONE E-MAILADDRESS ^ <br /> .4.i_ '*OA • - , 77@_ e I f.c0a1 I e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e Plan including location <br /> AGENT ADIR--S CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etb ks <br /> PHONE PHONE ite Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> F or ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) e <br /> evation of property <br /> PARCEL NUMBER: CURRENTZO ING: ACREAGE: p p <br /> El NUMBER c'zq Io-4.43-S690- r. p - / C. & frontage drawn to scale. <br /> TOW HIP: SEC ION <br /> r 2 t . (,� 1/: J % J ,%41/4:5 ❑ Dr' e - •ermits <br /> J ADDRES,� <br /> �J� ( -, •unty,town) <br /> 6 ''NJ ' ''\ 1.--o''■"-e- 0 lit Sanitary permits <br /> /1//1,1` I LOT SUBDIVISION BLOCK/LOT (public,private) � > <br /> PROPOSED PROJECT INFORMATION <br /> 5` & 3, TJ�FVRE1�.1 .,��= <br /> PROJECT DESCRIPTION: � r <br /> �.<:,I 6 UI 6 -.. ® e <br /> This project is a new building or structure. <br /> • ��,� , iil := -g� <br /> ❑This project is an addition/alteration to an existing building or structure. 4-44 ? .; ,z- <br /> SANITARY SERVICE: PERMIT NUM R: A _. 'E .,T <br /> SEWER EPTIC 4J i '4- t, <br /> HEIGHT IN FEET: NUMBER OF ST IES: (Not including basement) t-�_ " '' `-,• ,r- <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ?4•tr- 'i-.a. �4;. <br /> �� �c,on€off Car" <br /> BASEMENT: 1ST FLOOR:(4 < <br /> 1 4, TOTAL SQUARE FOOTAGE: 4, �. ���r ��C� <br /> s €ice r 11) V ;i; <br /> 2ND FLOOR: 3RD FLOOR 1 <br /> I �} �.�o <br /> ESTIMATED CONSTRUCTION COST: -+ -+ --► --► -+ $ e o i� <br /> (Please round to nearest dollar) •Pk a., .._.,.:: ,...-...-_f,-f.: , <br /> 1. The ro erty is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No ❑Don't know <br /> P P <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? AqYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes NINo <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 t7 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes :01j o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -4 —► <br /> 545-112(4/08) <br />