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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 /j n <br /> / y.50n ` A C ,'11 71 g f'yC►n 1 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7 SG a i0•e0/ Cox. -r t'c i 1 lr'c cli.5on, 1J 1 53 /2 Variance(# ) <br /> *ME PHONE CELL PHONE gel— E-MAIL ADDRESS <br /> 0o8 2o3 -5.5/a 3 ,312- 0Z26 .n • r art.7-G! itc?t/1741 'co ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME/ / , 1 CON-TRACTOR NAME, <br /> /^� �-e N v I( S`�c, 7 �1 G NOb1�I 6Gt /curs _Tile.,❑ Site Plan including location <br /> AGENT ADDRRRRESS CONTRACTOR ADDRESS of well/septic <br /> 7923 4ir= c r led , — 6c,in e_ <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> /)/)iddbero n GJ 1 535`6 a <br /> PHONE i PHONE ❑ Site Plan approval from <br /> (�' J 83/_ imzz applicable township. <br /> E-MAIL AbDRESS E-MAIL ADDRESS <br /> Act rTO.,d e noble, ti dalef'S ,co"I ❑ 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 Q�O�_3a3-loo —0 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/4: 1/41/4: Driveway permits <br /> �/��^ (state,county,town) <br /> ADDRESS: <br /> CSM: LOT SUBDIVISION BLOCK/LOT Lla unitary permits <br /> 2. )4(4.41/Mil °0 /Id (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> ST �� ,;1-_:;,,„:,- <br /> PROJECT DESCRIPTION: s" <br /> 3 ,e <br /> This project is a new building or structure. <br /> • P 1 9 <br /> .e.‘ ��Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> s <br /> SANITARY SERVICE: PERMIT NUMBER: z o1�, <br /> (SEWER ]SEPTIC /3 - 2 Of 5—-- 0 o 33 7 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' <,,,,,,,,1-,,,/'; <br /> 3y 2 VI t 1 2.i ' <br /> AREA TO NEAREST SQUARE FOOT: • <br /> (Outside dimensions including unfinished area, attached ga-ages and above grade decks or porches) �� , I troi pontiff <br /> BASEMENT: 1ST FLOOR: 7^� v ?yam s, <br /> 3 'SV/ j TOTAL SQUARE FOOTAGE: j i//r �- 1 t; - <br /> 2ND FLOOR: 3RD FLOOR: ^ 7?-1 <br /> ESTIMATED CONSTRUCTION COST: _t. ♦ $ g gi €+ us <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ 67��i (rte <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes El No 12 Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ['Yes ❑No El Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement'? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ['Yes ®No <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) ❑Yeslo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 545-112(4/08) <br />