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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 <br /> "-:-)"��' _.,\1 <br /> \,,,t=e2- 11.-ZT-ling Status;CUP; <br /> OWNER ADDRESS (Number,Str et,City,State,Zip) <br /> S4''1% -vv � Deed Restriction; CSM <br /> d / al / � c Variance(# ) <br /> Id� /6 5 L.F�O 4Ko Q1<:)1 DRESS <br /> `� o„�DD®N •�� cow ite Plan drawn to scale <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> INFORMATION CONTRACTOR INFORMATION - _. and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS CONTRACTOR AD.- S of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE - PHONE ------ U ite Play- prov-.,om <br /> app l• ble township , f 7' <br /> E-MAILADDRESS E-MAIL ADDRESS � <br /> Q Rot .tans to scale "` <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi us/) <br /> vation of ro e <br /> PARENT PARCEL NUMBER: CURRENTZpNING: ACR E: p p <br /> ElPARCEL ^ l _ / f frontage drawn to scale. <br /> NUMBER `���� r E3"��� O � � l <br /> TOWkSHIP: SECTION: <br /> d °1 .LvY-10 -( 1,-1,, / 4 1/: _SLR/ 1/4'/a: hI 1„) ❑ Drive rmits <br /> ADDRES (st , CO ty,town) <br /> 11' • Ck I Lisa • :a •ermits <br /> CSM: LOT )71/) A SUBDIVISION BLOCK/LOT (pub• , p ' ate) <br /> PROPOSED PROJECT INFORMATION s� "$TAIFIk REVIEW°may`; <br /> PROJECT D SCRIPTION: �" - .. ‹.` __r.sj <br /> ❑This project is a new building or structure. nor <br /> ❑This project is an addition/alteration to an existing building or structure. Y 5 --:" ;. <br /> SANITARY SERVICE: PERMIT NUMBER:j E ' -'d• S x - `t <br /> (SEWER SEPTIC �/ / z '' t �Zt:"� r <br /> HEIGHT IN FEET NUMBER OF ST RIES: (Not including basement) "� , <br /> a <br /> AREA TO NEAREST SQUARE FOOT : -7 >u '_' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �-'{-`1 L I` <br /> 048fgoi�ao s E -Jl <br /> BASEMENT 1ST FLOOR: _� w�:�- n <br /> 1 _ 4, TOTAL SQUARE FOOTAGE: j, 130 -i.o{ ['` T�e�t'Tp `" :fir 4 6 <br /> 2ND FLOOR: 3RD FLOOR:/ s0€r-0'.r a SS 'Y s <br /> c1 � A - <br /> si",31b Cz fyt;tti a mss; V <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ t s €c 1:1a 0 o i~e <br /> (Please round to nearest dollar) $ I g , emu, <br /> 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 'es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes -allo ❑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 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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* 4. -♦ <br /> 545-112(4/08) <br />