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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWAME <br /> 1'SUS5LL4— G.4 A/ G ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 5 Deed Restriction; CSM <br /> �7 5 �V. 2 LL �� %i t/% C/1��5 ; �rA/5 5 3 5 t3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (6C 798- 4/gig (,c4 Vo/-9,268 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME/ <br /> Z. X <br /> AGENT ADDRESS CONTRACTOR ADDRESS ���.r0�� ❑ of well/septic <br /> including location <br /> 0015 Tim;,,/4-t be. *I l4..9 e <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> ire 1'1/Z L..dt A/0 , GU-7 .5 3.5-9 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (66a) o' / - 300e) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL o -7- 063 R-3 f--� ;8111 Z- frontage drawn to scale. <br /> NUMBER ©©� <br /> TOWNSHIP: SECTION: <br /> 6e rrl !mob 1/4: 1/41/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: � <br /> S—/7C 4 ///t/1 PD/'cwt- "d ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (3 3 D f (public,private) <br /> PROPOSED PROJECT INFORMATION -% t <br /> PROJECT DESCRIPTION: f + a * , <br /> I L c x ' ,6-i2 • D C Zoning District <br /> . ❑This project is a new building or structure. Pe U *Witt <br /> ®This project is an addition/alteration to an existing building or structure. " <br /> SANITARY SERVICE: PERMIT NUMBER: U Rural Address <br /> fSEWER PTIC nnr/ex <br /> HEIGHT IN FEET: f NUMBER OF STORIES: (Not including basement) <br /> i !, S 10 M W$tla a •a e a alb <br /> AREA TO NEAREST SQUARE FOOT: ,;v a S ,y,, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> : „04,,0.0.; �t <br /> BASEMENT: 1ST FLOOR: (�,. 1 <br /> 4 <br /> TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: <br /> -7a akeview Location Survey <br /> ESTIMATED CONSTRUCTION COST: D�' td availabl /]bons.. <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 [✓]rNo ❑Don't know <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'? El Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [v]'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 ❑No Etbon't know <br /> 7. Is this to correct a violation? ❑Yes [✓]'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />