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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWy.11 NAME f /v/ <br /> B hh / r / e '� Al Zoning Status; CUP; A <br /> OWNER ADDRESS (Number,Street,Ci ,Stat4Zip),7, i !� 1_ Deed Restriction; CSM <br /> 3 �'1 G7 � �' r 4 s V/ 5 9 °� Variance(# ) <br /> HOME PHONE GEtC'PHONE wD r/- E-MAIL ADDRESS <br /> Ae:E'3'NT-�9�- y,2 S�' e2 6 3 9 c'1 0(Site Plan drawn to scale <br /> INFORMATION CONTRACTOR INFORMATION and includes dil 1p,nsions <br /> AGENT NAME CONTRA TOR NAME / <br /> Ii ' in Plan_inrlii ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se•ti <br /> �/ 2//6/ <br /> (City,State,Zip) (City,Stag,Zip) *Setbacks � � <br /> Site Planapproval from/ <br /> V/0_ <br /> PHONE PP <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS 0;2 Floor plans to scale <br /> • <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PART PARCEL NUMBER: CURREN, Z�OO1NING: ACREAGE: �f <br /> El NUMBER <br /> 0).8 0 /161'/D 3-r60b `T`/ ��( 3 �, 1 frontage drawn to scale. <br /> TOWNSHIP: SECT CT# <br /> p/ �� 1 1 4/ sh/ Drivew. •- mits <br /> d osy / _ '/a: /a/a: (stag • town) <br /> ADDRESS: <br /> i) 3(/ I f1' <br /> CSM: L T SUBDIVISION BLOCK/LOT Sanitary •- •I its „//4 <br /> (publirtg - _ Iv <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW ' <br /> PROJECT DESCR Of)f f /` ',,/ fcc i AV l 7 �' V 1l (ND 0 ' fl Zoning District ` .� <br /> Q This project is a new building or structure. k r e ►a :Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: lltiraf Adr A <br /> ❑SEWER 9 SEPTIC (new St[n• " a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Pty s io0dpiain/ <br /> /V °horelart• (a�ctment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> �Eroslo0eortlEgt e,,, , <br /> BASEMENT: 1ST FLOOR: �� wA <br /> 22 <br /> 4, TOTAL SQUARE FOOTAGE: ,` (slopes,�dlstUr• �£�* <br /> 2ND FLOOR: 3RD FLOOR: <br /> �� �-� fili,Iing�acceSS <br /> f_ Review Locepprl Survey.' <br /> ESTIMATED CONSTRUCTION COST: y� and available options .x , <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? DYes ❑No ❑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? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? DYes ❑No <br /> x,00 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► —► <br /> 545-112(4/08) <br />