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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> WNER NAM <br /> ---04-A i \ A-RetA-MoN) tr(A4-e-c--OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> LDDR 0 ' 1{ lr�,) !��-1'�C -1- Deed Restriction; CSM <br /> t-4 Ck vJ w W i 535 3 Variance(# ) <br /> ��,1° -;• a'HONE CELL PHONE E-MAILADDRESS) <br /> ��- �fw.�>ZZo� 7...b.---'- �G,r 0 � Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME r CONTRACTOR NE <br /> S* 5 c\ • e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) s6kS <br /> PHONE PHONE ❑ Site Pan ap roval from <br /> applica ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> IF)Oor plans o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) EI ion of property <br /> PARENT PARCEL NUMBER: CURRENT ON G: ACREAGE <br /> ❑ PARCEL 1 nn ' 1 l /n l .0 ontage drawn to scale. <br /> NUMBER Qq 1 lJ n � 1 � n� �–U �� <br /> TOWNSHIP: ECTION: r / I <br /> \N- Z g 1/4: N - 1/1/: A) IN ❑ Drivew ermits <br /> (stat , nty,town) <br /> ADDRESS: <br /> v— Lt g 0 14 c,wZ iv--0., "De,'s o,r-�k 4.- <br /> El Sanita N p-r its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> t7 O 1 — — (publi�'vate) <br /> PROPOSED PROJECT INFORMATION -k REV.( " , <br /> PROJECT DESCRIPTION: <br /> ,a g`= Ems„ ^- <br /> . TA This project is a new building or structure. r �� : <br /> -1-� '" <br /> This project is an addition/alteration to an existing building or structure. �;� g <br /> SANITARY SERVICE: PERMIT NUMBS glAr*-Allr.A451-t;-t D' <br /> SEWER SEPTIC ' M;; f � � <br /> HEIGHT IN FEET NUMBER OF TO I (Not including basement) z4 ,., <br /> o• a.'rn <br /> c end 1, <br /> AREA TO NEAREST SQUARE FOOT: y <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) `7 <br /> BASEMENT: 1'6pL 1ST FLOOR: L e j K. o f Q v g s Z1 , 1�S S 1 TOTAL SQUARE FOOTAGE: ,, r j,4._I,-i`^fie <br /> 2ND FLOOR: 3RD FLOOR: L !''''.` :" <br /> gr r-$ of lY'AkP .-t o *,,, j,..,,:„_ <br /> ESTIMATED CONSTRUCTION COST: l'f t:j°" ®e itf'**-1:j <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? Oyes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 11 yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes p 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? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -► <br /> 545-112(4/08) <br />