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• <br /> ?/ it <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> r'r A R UC K L R"T Zoning Status; CUP; <br /> v OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4515' REENGRASS RDE-MAIL/ M A D IS QIJ1 1,01 X37 I variance(# ) <br /> HOME PHONE CELL PHONE ADRESS <br /> A.21-4o9 I "4 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION :nd includes dimensions <br /> AGENT NAME C""O�rNTRACCTOR NAME <br /> TO �+ <br /> AGENT ADDRESS CONTRACTOR ADDRESS r Sitwell/Septl�luding location <br /> i E7ol1b' HEts1 K RD <br /> v(City,State,Zip) (City,State,Zip) Setbacks <br /> No RT) F REEDo�( WI <br /> PHONE PHONE �Slte n a royal from <br /> 16 8- ��141- a,2 o,39�"/ ! �, <br /> ppli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CU ENT NING: ACREAGE: ❑ Elevation Of props <br /> El NU <br /> NUMBER C7/l- 0104-r,easo:3 f- e2\ 1.4 frontage drawn to scal - <br /> TOWNSHIP: SECTIO ,- <br /> COTTAGE GRo I E ' : S ih :S r ,4Drivew is <br /> ADDRESS: (st ,c nty,town) <br /> 45/5- G REENGRAss R D Sanir. . -rmits <br /> CSM: LOT SUBDIVISI•N BLOCK/LOT <br /> TH 'DT)- (public • ate) <br /> — I. • • • 5 S d <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: I C-C-?(' -c <br /> AD-D / e.AR GA RAG E To EX[ST/rtc STKue'ruRE Zoning District <br /> ❑This project is a new building or structure. - ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER:w I ,1ural A <br /> ❑SEWER XSEPTIC U, I , (ne existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I ,\Wetly F plain/ <br /> Sho (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gauges and above grade decks or porches) <br /> BASEMENT: 1ST FLO R: <br /> Eros*- • trot permit <br /> ,, TOTAL SQUARE FOOTAGE: , (slopes, ,sturbanCe, <br /> filling!- 4 ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> '�f ,Review •�� .•n Survey <br /> ESTIM ED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► 0.-.6 and ava- =: - options. <br /> (Please round to nearest dollar) $ 0`0 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IN No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 5ifNo ❑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 ,11No <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? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -i -► <br /> 545-112(4/08) <br />