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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 /> L�� l?v t� �'--' //—Z 7 ❑ Zoning Status; CUP; <br /> OWNER ADD ESS (N ber,Street,City,State,Zip) Deed Restriction; CSM <br /> /// Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Oaz-C4!Y-3Y. "e--7 n <br /> / dir., Site Plan d to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includ imensions <br /> AGENT NAME / / CONT OR NAME <br /> � �� �� i #rr ,!J6 ❑ Site Plan including location <br /> AGE TADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State Zip) (City,State,Zip) ❑ SoiCkS <br /> 4 4‘1/Z5'7'4/ -' a <br /> PHONE PHONE ❑ Site Pla p rom <br /> ' ' -'5/"" <br /> 9'1./2 hip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ‘� � ,� �, b ❑ Floor plans to ca <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONIN • ACREAGE: ❑ Elevation of property tik❑ NUMBER 0.4 o 0 — 3 Z fJ t ° �1 'z, Sai/fi.- frontage dravtt scale. <br /> TOWNSHIP: / _ i SECTION: <br /> 17C- �� 7��� ,/o. 1�1�4: El Driveway r <br /> ADDRESS:/��/ �7 / '-7 (State,c <br /> Z ',7, lam 7 /8/ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION LOCK/LOT S <br /> /� sl J (Public,{;ivte) <br /> PROPOSED PROJECT INFORMATION Sri <br /> PROJECT DESCRIPT N�, ,. i <br /> 7,9 chi � irt/y / ;/.77-0 • �4,Zoning ' tncf ':,-„,,„ <br /> . This project is a new building or structure. UPS se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> �'` al ess <br /> SANITARY SERVICE: PERMIT NUMBER: � ' �,z <br /> (SEWER SEPTIC /? 27/ ! � �r <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including/ we£ ,. « 3 , <br /> stir? :" <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> /�2 3 2r + TOTAL SQUARE FOOTAGE: + Jun',:,.;` ,:: ::: :',1.«c ' } <br /> 2ND FLOOR: 3RD FLOOR. ��� <br /> ESTIMATED CONSTRUCTION COST: � c f €• ,f <br /> Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 4 Flo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ,aI o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dtes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Et-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) ❑Yes 1No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes RNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />