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85,& SUPPLEMENT to Web-App if_ <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �+ <br /> t# &r1:1-c,And r'`.+-c, t'e'rn t'�t 0 S n Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> as o l Town (-lal( i Kos,Al- /Icrclo Lt.)z 5J5 7 2- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION, - CONTRACTOR INFORMATION ,- and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> !far &dCivla n .Oman Du. Iders LL C— n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> -7 S7/ Coo,' r SQn•A__ <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Foresi- , wT 53S32 San, 4_ <br /> PHONE PHONE <br /> n Site Plan approval from <br /> (wog- S -62°/6 (ovg --Ei Lt h -- 3 3 eq applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> K-r I e 6e.c k.ha f\b, 6e-rs.c.,,M SacY\-2, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION'.(http a/accessdane.co.dane.wi.:us/)„ , _ _ .❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER /01- C Sin /0(1 Lt 7 A - i s'• O 3 t-/ <br /> TOWNSHIP: SECTION: <br /> /4: %,A: ❑ Driveway permits• <br /> S(�r.n �a 2 (state,county,town) <br /> ADDRESS: <br /> '?aOI Twn Na(( 2J dt1ov1‘+ 11c)r4b to Z. 5.3S72_ <br /> 111 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I o 4 c2 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF'REVI Y= <br /> PROJECT DESCRIPTION: ` rte t- 3 .° °"` ` <br /> Ex4-eAd �<.',bins kc aA . (s L.,- 18 a c '�,-11.1 We. 1 ( iW .=oramg D s:`V t . <br /> . ❑This project is a new building or structure. ,@` � <br /> This project is an addition/alteration to an existing building or structure. 4: _ .�,} 43 <br /> SANITARY SERVICE: PERMIT NUMBER: -'d° .S r = ; <br /> F1SEWER SEPTIC 4 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) .4' 4`� �� <br /> ;VVetia, °%�°od® ` <br /> irk horean°Ia e-chrnent) , <br /> AREA TO NEAREST SQUARE FOOT: 7-�. ` �,,� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '` _ z ' s � <br /> BASEMENT: 1ST FLO ,;r .u, .. .�r. ,- <br /> 4' 1 TOTAL SQUARE FOOTAGE: j, f�°e °1SL' ®ardc� , ' <br /> _ t ils°a v- .y - <br /> 2ND FLOOR: 3RD FLOOR: s <br /> ESTIMATED CONSTRUCTION COST: $ c� vvO, O k„ °- o o i.- <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ $ / v tom : dW� x.5- -, ' : Y-w <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l 'No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ElYes ❑No ©Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ©Yes ❑No <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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► =■ -♦ <br /> 545-112(4/08) <br />