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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME KE 4 " <br /> I '�}' A ,, <br /> ►►t oar-AA) c ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /, — Deed Restriction; CSM <br /> 96/ �/1/7/4//90/-Z / ! %'(� IV ILOW� c . Z .C1 ? Variance(# ) <br /> HOME PHONE 5,.,`2 CELL PHONE E-MAIL ADDRESS <br /> i-S 7'3 1 Y s ESite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (U ) LJ&U ' ;c Iite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1O &/ elk° OED <br /> (City,State,Zip) (City,State,Zip) ID4etbacks <br /> LuE liq/ utir.s 3S/7 <br /> PHONE PHONE Site Plan approval from <br /> (poi — C13? -j(p(7Z_ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rnie&W Iscc-ko-)L,1/4■Abscapc5z3.0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> ElPARENT PARC[E NNUM{BER: X12 CURRENT ZONING: ACREAGE: <br /> NUMBER Og f/(/J r(�<J�xx— / F14-- I 2 i ) frontage drawn to scale. <br /> TOWNSHIP. SEC <br /> re V 1/. u.) 1/41/4. 6to ❑ Driveway permits <br /> ADDRESS: I� / . (state,county,town) <br /> �� aft, ,_ (, 53 S`707 El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION SrAFF REVD __ <br /> PROJECT DESCRIPTION:N D 7E S 9. a r k <br /> 21 his project is a new building or structure. I� �" <br /> ;'4 This project is an addition/alteration to an existing building or structure. ,,�� - �, <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> riSEWER OSEPTIC iliWeittlY, r <br /> �z: �twz <br /> HEIGHT IN FEET t NUMBER OF STORIES: (Not including basement) � <br /> 3Z 1 1 '''' 'ke ana !Ocilla , <br /> !o ; a r:climentg,5 <br /> AREA TO NEAREST SQUARE FOOT: s y'« , - - '�' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , - , <br /> BASEMENT: 1ST FLOOR: u.,� <br /> 4, TOTAL SQUARE FOOTAGE: ' a -y °I 1S?..� ^CRt <br /> 2ND FLOOR: 3RD FLOOR: , ip 7 j) :-1: ._--„- , <br /> Cry v <br /> ESTIMATED CONSTRUCTION COST: 'it'Win- a`s"""�(;1��'' o o:e ' <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? [ Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? El Yes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 'EYes ❑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 2 No ❑Don't know <br /> 7. Is this to correct a violation? Dyes ,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ =► ♦ <br /> 545-112(4/08) <br />