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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 /> 'T:om4 S Sr1V6L ❑ Zoning Status;CUP; <br /> OWNER ADDRESS-(Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 0/733 D�)mkil C/1-6(-6 Variance(# ) <br /> HOME PHONE `CELL PHONE E-MAIL ADDRESS <br /> S3736Sb ;a8-09e9 (A LS ' O 7dz,GOr>■ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) El Setbacks • <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: `� CURRENT ZONING: ACREAGE: <br /> © NUMBER O5e/Q81/•32i•9/65`4 `XNV1 a 1 c;-.c;-. frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .5,n ,Q)(Lth .1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: ` (state, county,town) <br /> c X 33 8m114 Q Gut& ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 86501 (public,private) <br /> PROPOSED PROJECT INFORMATION Vi;i!,.:STAFF4iA EVI <br /> PROJECT DESCRIPTION: ' <br /> g4/ ' Deck- -dp g old' •. <br /> This project is a new building or structure. s- <br /> 2This project is an addition/alteration to an existing building or structure. _ . <br /> SANITARY SERVICE: PERMIT NUMBER: � a- e dress's : <br /> nSEWER SEPTICFl )I <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '',4 4 it ' <br /> U Wet and/ �ptaU� -,i <br /> s „Sl�breland (a tacrnent) <br /> AREA TO NEAREST SQUARE FOOT: . t , `- � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -r �j .L�` <br /> � a ,P11 .:. E e e erl <br /> BASEMENT: 1ST FLOOR: ': -'y ' <br /> 4, TOTAL SQUARE FOOTAGE: 4, s e m °.a lie % <br /> s <br /> 2ND FLOOR: 3RD FLOOR: O `° <br /> f > :-' <br /> / <br /> .e e t , _ , <br /> ESTIMATED CONSTRUCTION COST: $ . /3 g5 ane a ® Option A, <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ T °„ : .' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,I No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No H 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) EYes fNo ❑Don't know <br /> 7. Is this to correct a violation? 0 Yes Z1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />