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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION .countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A•DRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME N CcONTRA TOR NA E <br /> L_k_c-1'J u: ..e'-' 3T6U•- ,gCUl.../ ,2S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS of well/septic <br /> 30,1-> aft o N Cos�i,N o.- <br /> (City,State,z (City,Stat-,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> -. `Ait? applicable township. <br /> E-MAIL ADDRESS E-MAIL•'DRESS <br /> L.5.Li4 t°@ Kfr.&3fT ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑ NUMBER 4v/'i j1`7sy o frontage drawn to scale. <br /> 4 f <br /> TOWNSHIP: Ai SECTI••• <br /> s-TO ' ,/4_ S ,/,/4,s.L ❑ Driveway permits <br /> ADDRESS: (p CI Z3 (state,county,town) <br /> CSM: LOT SUBDIVI'ION BLOCK/LOT ❑ Sanitary permits <br /> Zit?- S N A` (public, private) <br /> PROPOSED PROJECT INFORMATION TO a R EV E1N:9- <br /> PROJECT DESCRIPTION: pej /ina4 s � ,,,, ,f ` <br /> � - <br /> tzt, <br /> - <br /> . ` This project is a new building or structure. r. • h @S6 lip <br /> ❑This project is an addition/alteration to an existin_ building or structure. �, '�e _;;:,..47,7�' <br /> SANITARY SERVICE: PERMIT BER: Q � ®_° <br /> (SEWER SEPTIC /J —,.•/% _opci? e i � e <br /> HEIGHT IN FEET ( NUMBER OF STORIES: (Not including basement) - a <br /> .3--- 3 etlan VW•p(]• <br /> — wl',.*}hoIe ra•"4a r:chment) <br /> – — . <br /> AREA TO NEAREST SOU' 'E FOOT: ��� - -E ,� <br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) , w�. z <br /> BASEMENT 1ST FLOOR: � 111 • en( • • � <br /> ��✓g2 3�� 0 4, TOTAL SQUARE FOOTAGE: ,, $ � <br /> 2ND FLOOR: 3RD OR: $ :.. , <br /> x tYt`1411� i o"@ sue, <br /> ESTIMATED CONSTRUCTION COST: � •PP,• ` <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 100" feet from a pond or lake? ❑Yes EINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro•erty? ❑Yes E No ❑Don't know <br /> 3. Have you talked with the township about your proj-ct and are they in agreement'? DYes ❑No <br /> 4. Has there been a zoning permit issued for this pro serty in the past 5 years? ❑Yes TENo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ['Yes g No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ –0 –► <br /> 545-112(4/08) <br />