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' SUPPLEMENT to Web•App#' <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OW NAME �,O <br /> J 1 ra `n- `C 6 a c J{ • ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 7) �/� eed Restriction; CSM <br /> 9 G/' 574'1 f G L,c, ( �i " Variance(# ) <br /> °ME PHONE 2 CELL PHONE E-MAIL ADDRESS <br /> tO �y (7J ��f/ (2 9 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFO RMATION: ' and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks / <br /> PHONE PHONE ❑ Site PlarfraKproval from <br /> o €./ app�/ ble towns ip. <br /> E-MAILADDRESS O ��D I j/ / MAILADDRESS <br /> ❑ loor s to scale <br /> PROPERTY/LOCATION INFORMATION (http pl/accessdane.co.dane.wi.usl) Elevation of property <br /> PARENT B '_ CURRENT ZONING: ACR�GE: <br /> ligPARCEL A —/ t( ,/ ) / ' j V frontage drawn scale. <br /> NUMBER /' <br /> TOWNSMP: SECTION' ,,1 <br /> �k c.t t /tom", / I ,�, 1 ._ .1/414. ,S ii 1 ❑ Drivewa rmits <br /> ADDREE/SS: �/ / GI �l (Stat ,count town) <br /> l l 0 4✓✓ s C in ai '- <br /> ❑ Sanita ypermits <br /> CSM: LOT / SUBDIVISION BLOCK/LOT c, private) <br /> /l <br /> PROPOSED PROJECT INFORMATION S S7# REvI °*a <br /> PROJECT D SCRIPTION: ® '"� " k',� �'� � -g <br /> � n p o t S� // i nm9 Q S Q ,-;. <br /> � fly 2F � „� <br /> te " " a, y ft} <br /> ❑This project is a new building or structure. 7 :a�� 9k, %f g. 0 aR <br /> This project is an addition Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER I _ _ �- <br /> ❑SEWER SEPTIC V TZk% F� L,IT.;.,-1.517_ ;..V , <br /> HEIGHT IN FEET / I NUMBER OF STORIES: ( of including basement) VTs,. ''fi'^� ?' * <br /> a•'+ohi) jl 6� Y <br /> AREA TO NEAREST SQUARE FOOT ` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ®r-;---70.,G aa <br /> BASEMENT: 1ST FLOOR: �� <br /> 4, TOTAL SQUARE FOOTAGE: , a"� Q o .g <br /> t2 /L d ,j AA_ <br /> t a <br /> 2ND FLOOR: 3RD FLOOR: rr - r 1 <br /> ESTIMATED CONSTRUCTION COST: it i€OrT4W11 0` o itie <br /> (Please round to nearest dollar) '♦ -i --► --► -► --► 2 O 0 • 0 a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes •Q 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 . BM ' <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENo <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 f No ❑Don't know <br /> 7. Is this to correct a violation? EYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ .4 <br /> 545-112(4/06) <br />