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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 Vend Pan V end to K. ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ i `• Deed Restriction; CSM <br /> - --1 02. C A v d 1 v\ak Po ►r1.-k T�a`1\ , 'M i c1,4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> '1—(3A C 5,211 k)V' ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2` 32 (c�rzerl <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Dua ititOO14dS ,1.0 i S351 7 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (,ODE — 22.E--?4 ct 4 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> --c i • c c tier& 144-,,i•co 1r1 El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) iii Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL <br /> d 3E5 f 0 06a_2.03-26/3-c. A_ I , 7[�( frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 'Tc vt O r it•t%ddk.e-on 1/4: INN: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9,1 '2 Car dir►a-t Poi r - TvaA I I Lr act L4 i'1 ❑ Sanitary permits <br /> CSM: LOT 4 SUBDIVISION t BLOCK/LOT <br /> -3 5 rYVCe 1io ��ot.� (public,private) <br /> l <br /> PROPOSED PROJECT INFORMATION T .1l`REV <br /> PROJECT DESCRIPTION: <br /> Marv-t g-axvit a ck 4i o ig xv <br /> . ❑This project is a new building or structure. ,1 : <br /> ,This project is an addition/alteration to an existing building or structure. $ •; <br /> � <br /> � <br /> SANITARY SERVICE: PERMIT NUMBER: t s , _. <br /> FISEWER IRISEPTIC S' �-t4,7444,:;;,4-7-t,;-4,e4 r :,i' .BT <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �°;xx " 1- '¢ `,, <br /> IS `J ( ate_ Q ,na® <br /> xq� ore° Terc pie' t) <br /> AREA TO NEAREST SQUARE FOOT: : .� u . <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 'g== ` !` � <br /> BASEMENT: 1ST FLOOR: _S 1 = op o _� r@ - � <br /> g4, TOTAL SQUARE FOOTAGE: r� o €t e. �, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 96 <br /> a <br /> ESTIMATED CONSTRUCTION COST: ' *' 01' e o 7 =; <br /> (Please round to nearest dollar) q O/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ® No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes 12 No ['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? 0 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 ©No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes R]No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -* <br /> 545-112(4/08) <br />