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SUPPLEMENT to Web=App#'_: <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION - C )STOMER TO PROVIDE <br /> OWNER NAME <br /> Tun' fSs.ozr Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> I`ktRe Sko . ikwy 412— V OSi 17 0 ++ 5�' g 3 Variance(# ) <br /> OME P TONE r CELL PHONE E-MAILADDRESS <br /> 0%,P , — 'CO—.. S' e Plan drawn to scale <br /> AGENT INFORM ATION: CONTRACTOR INFORMATION -_ nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> trt,J OW b102- P,n„V 1A,1d ivS 5 - e Plan including location <br /> AGENT ADDRESS oti. CONTRACTOR ADDRESS fwell/septic <br /> 5S4o 5}0E•c So Sup-1-t (02- <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> De 1tuc.- , wT 5311 5 <br /> PHONE PHONE ❑ le Pla pproval from <br /> 60S- (Pi5- S1,k\ ppli le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Broil C 0 R_A P tvtn o . C.01,,.1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION_ (httpa/accessdane.co.dane wi usl)„ , Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONI G: ACREAGE: <br /> ❑ PARCEL 06© Ng- )0 .- 1 3� frontage drawn scale. <br /> NUMBER t ^ <br /> TOWNSHIP: SECTION: <br /> r I IAN c o e ,/: 1/41/4. ❑ Drivew permits <br /> ADDRESS: 1l (stat ,cou y,town) <br /> 144(0 `944 '( 'f�wY Ci2' ❑ Sanit. permits <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT (• • ic, private) <br /> PROPOSED PROJECT INFORMATION s TAfF RE1/IEIN = <br /> PROJECT DESCRIPTIO • I '' f fit ;s •szrs <br /> 411 1Z) a 0, iffsm 0 41•nmgzli nca l <br /> x"„47` -°` <br /> . This project is a new building or structure. 'E RPermltf-ss, 7 v- '` <br /> ❑This project is an additio alteration to an existing building or structure. � a `- <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R'ja�I ' 0•re - <br /> OeWie stir'®�nSEWER SEPTIC 1 . <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) '? �., <br /> E Wetland -ood. a . <br /> - Shorerrcl a ti di ntj `' <br /> AREA TO NEAREST SQUARE FOOT: --,,,-,,e,--2---� � ' - '•_, <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - � ; "` -3 <br /> - Erosioncont . ermit <br /> BASEMENT: 1ST FLOOR: P >-u'- -Ili?: <br /> TOTAL SQUARE FOOTAGE: l'''''(S ape :r3 -.anc <br /> V fitlrrig/ ; _ <br /> 2ND FLOOR: 3RD FLOOR: irtava:,' rt, r� <br /> v`►(� yRe e t=oca tor�r.Surve <br /> ESTIMATED CONSTRUCTION COST: G aii' d ait`a.a option - <br /> (Please round to nearest dollar) '♦ -* - -► ♦ ♦ $ � I t 0o b �' Nq � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 12<o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �i No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? eYes ❑No ' <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['es ❑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) ❑ s o ❑Don't know <br /> 7. Is this to correct a violation? Yes to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -► -♦ <br /> 545-112(4/08) <br />