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li Li( S <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> Nil <br /> f2 <br /> ❑Zoning Status;CUP; <br /> 0W)ER ESS tt(Number,Street,City, tate,Zip) -/� <br /> 1p r( ( AA-ryas (A f A A . C' ' -* tc �/t s-)55,7 Deed Variance Restriction; CSM <br /> HO PHONE-7 a CELL PHONE I E-MAIL ADDRESS Variance(# ) <br /> /7 177 / Coaa t✓A - - 4400•C0+^--) <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ANT E CONTRACTOR NAME <br /> �1 - ki•141J KA-•�►•keEE f r'k rLIA1 F+ ❑Site Plan including location <br /> A ENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /00/ /rshJt 41 -S• �.---- si1/4v i c <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> bog vyp.- 2/37.- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL /�j a. � frontage drawn to scale. <br /> NUMBER `�10 tp�XS�Y3/T-o , A— . 1?7 <br /> TOW HIP: SECTION: <br /> VI tJA-- 1h: V,4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 46,f 4,Irr-•t,‹._ /4*-7 .fl . ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 5/ n v aiX (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> App 4 SEsddnJ D,ocar-r i eg,..)t•-1. Ey4,ST/t< Dw aft-- ❑ Zoning District <br /> 111Ths_p.r.oject is a new building or structure. Li Permitted Use? <br /> RIellis project is an addition/alteration to an existing building or structure. -� <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> M AA, 17 ` ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> ATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 1ST FLOOR: 1 ^ ❑ ErosionControl permit <br /> 2211 A.- �j� I 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> / J' filling/access) <br /> 2ND FLOOR: 1 3RD FLOOR: l�JGi L,oczf <br /> Y `l4 ✓7-2, ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ ��/�OO and available options. <br /> (Please round to nearest dollar) (/ J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? El< ON <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 ENO"EDon't know <br /> 7. Is this to correct a violation? Elves Bib-- <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —* —+ <br />