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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU•TOMER TO PROVIDE <br /> OWNER NAME <br /> 461A-tad arm gi Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> R O. god( 1-45'1 I-4 aCi SU1?r WI 531 kill ariance(# ) <br /> HOME PHONE CELL PHONE I E-MAIL ADDRESS <br /> n Q, reo8=atq- i ri a ,ra, „-re g ea' -anC i , ' i ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME Q� �,_ , e ,/ ' CONTRACTOR NAME <br /> )ancU3o + T e(1I'R?�r ite Plan including location <br /> AGENT ADDRESS � ��5� „_r� CONTRACTOR ADDRESS of well/septic <br /> (City,SStatee,,Zip) (City,/U�', (City,State,Zip) Setbacks <br /> \yO 1a 1 W i 535913 <br /> PHONE PHONE ❑ S.a Plan proval from <br /> 60 8--.d ig_ )I a_ a plic e township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> .5.1.1. 0-A00\tt, 0 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> '�t ∎UMBER o6)0s-o(2I-aayo-o A-3 DGP2Z aoli-l-l0-7oa. 35sa3q frontage drawn t ale. <br /> T•1`r SHIP: SECT N 1 <br /> 1/e roy>� Y<: +v 1/4.1/4: N F ❑Drivewa ermits <br /> ADDRESS: (stat ,count •wn) <br /> 1Ix113 11Ic 1A)h R Vexonck , W 1 X9,3 vlo vnaatbh <br /> C► Sanit- permits <br /> CSM: LOT BLOCK/LOT <br /> 3g0y ' (. • lc,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / / <br /> A 4�ra t Ier is be i n9 h r'ou9 h- in iD Scrve as Act sxac..t . ��� WO ® , ing District <br /> . ►l This project is a new jg for structure. , °.ermitted Use? <br /> This project is an addteration to an existing building or tr ct re. r� <br /> SANITARY SERVICE: r�.1m rictGC4 PERMIT NUMBER: ❑ Rural ` •., <br /> EWER IC (flew/@.,z+tng <br /> HE IGHT IN FEET I NUMBER OF STORIES: (Not including basement) <br /> .i ❑ wets • ••• ,in/ <br /> Shore;AREA TO NEAREST SQUARE FOOT: d ( a t) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ❑ E .�ion • trot pemnit <br /> BASEMENT: 1ST FLOOR: <br /> iq a f Or x 44 4 I LH n 4(t j TOTAL SQUARE FOOTAGE: +, ( °a�*`,disturbance, <br /> 2ND FLOOR: (0, 3RD FLOOR: -1 1°t' Lit-to -P-t-1- f11Er -ef access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: • ♦ • -I, -4. $ // /l C and available options. <br /> (Please round to nearest dollar) ti t <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Q1'es o QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? fres o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Wes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes E3Vo <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) 01'es l ° ❑Don't know <br /> 7. Is this to correct a violation? Q1'es to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ♦ -♦ <br /> 545-112(4/08) <br />