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7 • 625) <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CZZA14 lC 140)4 1.67 ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /60 CT�• A O 4t 'W:2: Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ZGZ»1. -127 60 5 SF-k.4E6? /42)ea.41 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Or-4669 E t • ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> y vet L FeM¢ae() , <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> JW415cN , telt 537/60 <br /> PHONE PHONE ❑Site Plan approval from <br /> 4,08'-3/4-7lo 5'9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> C se 444 - *1`1,-- ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑ <br /> NUMBER Clv/�—X03 -182,-6- laN - 7,CO frontage drawn to scale. <br /> TT WNSHIP: SECTION: <br /> 1,`MTV(S�-/h' 1,4A <br /> '/; 1/,1/,: El Driveway permits <br /> ADDRESS: (state,county,town) <br /> /& C r. A CAMataic l�/ <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> \ (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> &./,b DEe� ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> ''this project is an addition/alteration to an existing building or structure. , <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑ Rural Address <br /> EWER [)EPTIC (flewf xis 'IQ) , it <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) �y���qyJ) .fib i <br /> El AREA TO NEAREST SQUARE FOOT �` 1N) ( ( <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ,] ' ' (,, i "'^ <br /> ❑ �islan� �� �, d <br /> BASEMENT 1ST FLOOR: <br /> Z/_9 4, TOTAL SQUARE FOOTAGE: 4, (slopes,di - 6* , °` <br /> c�U/ filling/accosts) a: <br /> 2ND FLOOR: 3RD FLOOR: y��- <br /> 369 f ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ �� = and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ '♦ ♦ •P �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 21Alo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo O 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) Elves ❑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 />