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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 /> / O/ S� *M ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7 U�Gl4S l'Z Cc7/J6FG,A" G7/ 6,JL� Variance(# ) <br /> " HOME PHONE CELL PHONE E-MAILADDRESS <br /> • 3 ; , Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ) ' f �-7-? ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> �O f3ox 3cS� <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> /a(� ,17/ 2 -- .3$ '(O applicable township. <br /> E-MAIL ADDRESS E-MAIL A RESS <br /> /GUG2�-+�64c��1ZC� l� �' by, Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL UMBEg: CURREN'rZONING: ACREAGE: <br /> ❑ PARCEL U/tg 07/ frontage drawn to scale. <br /> NUMBER a13 3(r'J7—`/ P— l /, 3/� <br /> TOWNSHIP: SECTION 5d-.77c-1 <br /> %O(,J,k/ 0(= G'0771.1 j� 60)(1= Ai Cd '/4: S l�l '/4'/4: ❑ Driveway permits <br /> ADDRESS: K t/ (state,county,town) <br /> 37 8� U/GGs= /Z O G c3 TJ6tGrit' G7/ev�6 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ST 37 ;•1, Sk f//. , (public,private) <br /> PROPOSED PROJECT INFORMATION xi- <br /> PROJECT DESCRIPTION: <br /> GL4/z GI j4 K69ca . , pct <br /> • M This project is a new building or structure. <br /> chr.h41,-AN s.'' . :',':" <br /> ❑This project is an addition/alteration to an existing building or structure. / ` <br /> SANITARY SERVICE: PERMIT NUMBER: ° <br /> nSEWER �SERTIC <br /> HEIGHT IN/FEET: NUMBER OF STORIES: (Not including basement) <br /> / ftY 3$ <br /> /y �rj / s�-O : �� <br /> AREA TO NEAREST SQUARE FOOT: � � <br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) <br /> "' 2.BASEMENT: 1ST FLOOR: ��-.01 f ,. <br /> D distt<i 3 l� <br /> Z ya j TOTAL SQUARE FOOTAGE: + 7, #sarrVey <br /> Et( [#E M�s�. <br /> 2ND FLOOR: 3RD FLOOR: ° . ;1,4.1'� <br /> ESTIMATED CONSTRUCTION COST: - ��= <br /> -, 1S <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ 5 G)COG S 4r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? <br /> ❑Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> Eyes El No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes El 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 arezone/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 /> AT BE SIGNED <br /> (Continue PPLICATION on BackMUS) ♦ ♦SIGN_ <br /> %D <br /> (4/08) <br />