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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www4countyofdane.com . <br /> PROPERTY OWNER INFORMATION 1 CUSTOMER TO PROVIDE <br /> OWNER NAME s S / Qy✓►\ f'r/t . a-- _A�0(5'�l ` <br /> gds.-� ?� ,A L, it 4 Zoning Status; CUP; C j <br /> � Deed Restriction; CSM '' p9y <br /> OWNER ADDRESS (Number,Street,City, tate,Zip) 'Sc f1 �_ `�^7©� <br /> 3�18 �� I0.A� C,� �( J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDES,S� � � 1,00 = it/evi <br /> oe_576_ S2-5 DS-}6 l 1 <br /> Site Plan drawn to scale <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT INFORMATION CONTRACTOR NAME <br /> AGENT NAME CONTRACTOR Plan including location#i <br /> CONTRACTOR ADDRESS of well/septic / <br /> AGENT ADDRESS L �� � <br /> (City,State,Zip) <br /> (City,State,Zip) Setbacks J/Or1/2 S(T)4,)1, <br /> PHONE 4Site Plan approval from` //4, <br /> PHONE applicable township. A/ <br /> E-MAILADDRESS E-MAIL ADDR SSloor plans to scale A///F <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property / ��/00 r <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR�EEAGE: frontage drawn to scale. <br /> (PARCEL 08lo-a'?-734/0-y C—Z �. 6 <br /> NUMBER SECflQN' S ;Driveway permits <br /> TOWNSHIP: j v(de- '� l/ V 144: c 1/414:• VV (state,count ,'o n <br /> ADDRESS: /1320 go�kt- (. <br /> L VC ,21 Sanita •-_r;'ts <br /> CSM: <br /> LOT SUBDIVISION BLOCK/LOT (publ' ,private <br /> PROPOSED PROJECT INFORMATION <br /> STAFFS lt�V## <br /> PROJECT 1P,P. iloN: AC 'S ■ <br /> .� I r` S>r�( � U rd �- Zoning District <br /> �� / <br /> . This project is a new building or structure. Permitted Use? 4 . <br /> ❑This project is an addition/alteration to an existing building or structure. ��'flu' s , , . <br /> SANITARY SERVICE: PERMIT NUMBER: :- <br /> ❑SEWER SEPTIC ,d ,` x <br /> HEIGHT IN FEET: i 5 NUMBER O' STORIES: (Not including basement) Wetland/Flood} ji>ii <br /> Shore1an0atta4$0e <br /> AREA TO NEAREST SQUAR: FOOT: a 5 <br /> (Outside dimensions including unfinished area, attached gara_es and above grade decks or porches) 'i� Ero'StonContrgtpermit ' <br /> BASEMENT: 1ST FLOOR: slo es,distelft*t e <br /> TOTAL SQUARE FOOTAGE: 4, p * ��,V; <br /> �- fiil6,0000ssy r <br /> 2ND FLOOR: 3RD FLOOR: /L'�— pl.'Review Location4Survey' <br /> an°d available aptF�ns � / <br /> ESTIMATED CONSTRUCTION COST: --► --► _♦ ♦ -,* ♦ l x y ' .� e /. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 eet from a pond or lake? ❑Yes 11 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? <br /> ❑Yes go ❑Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement? ❑Y s ❑No <br /> 4. Has there been a zoning permit issued for this prop rty in the past 5 years? (leave blank 0 N none) <br /> 5. Is this project associated with a rezone/CUP/varian a(petition/appeal# ) El Yes ❑No ❑Don't know <br /> 6. Is a location survey required? (see reverse) ❑Yes lo <br /> 7. Is this to correct a violation? <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -p -p <br /> 545-112(4/08) <br />