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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N i4' <br /> c.SrU.0i Ge_Yl. [l Zoning Status;CUP;14'2. <br /> OWNER ADDRESS ( m,er,Street,City,State,Zip) J �. .��-- <br /> S (OCR 410•._ W x35 Deed Restriction; CSM <br /> .?3 DS v a. `J 47, Variance(# ) <br /> H2O�wE PHONE CELL PHONE E-MAIL ADDRESS <br /> 44 otez S [Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT N E CONTRACTOR NAME <br /> CO VV IT . 533��, ry Cd©►M dSite Plan including location <br /> AGENT ADDRESS CONTRAC R ADDRESS of well/septic <br /> (4J3 010 S.►,jtCaw.�Ir_ S a..0-02.0 ■ <br /> (cay,state,zi ) �..7 (City,State,Zip) [Setbacks <br /> c3 1 : (I t e aa, "4 <br /> PHONE PHONE ❑ Site Plan approval fro <br /> or -a.ls 04{5 2_ tee.... applicable township.N P <br /> E-MAIL ADDRESS E-MAIL ADDRESS LJ Floor plans to scale <br /> ,......._____________PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER to S- /os,o ' y /'3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Pa Tri n x' 44# , ,/: , IA: ❑ Driveway permits \...,i 14 <br /> ADDRESS: '_oQ'x /O (state,county,town <br /> 3 a3 �''�"�"° CI Sanitary permits G , <br /> CSM: LOw 3 SUBDIVISION BLOCK/LOT W <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION '''4.4": STAFE'REVI y <br /> :. <br /> PROJECT DESCRIPTION: Q .r� � ° ;A <br /> 51 .cG0-s0 h 'Fe h s-k L`Oa ns�m i4 e <br /> "This project is a new building or structure. pi <br /> r' his project is an addition/alteration to an existing building or structure. � 5 <br /> SANITARY SERVICE: PERMIT NUMBER: t t s <br /> e g y riSEWER PEPTIC _ <br /> HEIGHT:title Q /�,�,�� NU ERR OF STORIES: (Not including basement)It <br /> 1 Ci� ' /T�+`5�� J�t71� m - f e o�,�m ado m x' " <br /> ""#��' %� horearam a t:cttment) <br /> AREA TO NEAREST SQUARE FOO : `. ; "1- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ ` <br /> BASEMENT: 1ST <br /> t1� • 4, TOTAL SQUARE FOOTAGE: ,j Q m m t it('m ,, ; " <br /> 2ND FLOOR: 3RD FLOOR: /6 e rt <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► -4 -4 ♦ c09i00�— m t IV4T; m® <br /> '(Please round to nearest dollar) <-' .. x. , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 60 ' C]Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? t�P es El No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? k es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1 to <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 1yr o ❑Don't know <br /> 7. Is this to correct a violation? ['Yes . !r o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0. —* —* <br /> 545-112(4/09) <br />