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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE'ONLY <br /> OWNER NAME _ <br /> I o S,S c� b r, e✓ Zoning District _ N ' . �r� , <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �� <br /> pp <br /> �)1 7 i(��+.'k c,c� eta )J 5)3- b Z ❑ Permitted Use? <br /> PHONE, -� E-MAI ADDRESS es1 h CA <br /> U Zoni Sta ;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Dee triction;CSM <br /> fi M CONTRACTOR NAME Vari Ce( <br /> l <br /> AGENT ADDRE CONTRACTOR ADDRESS <br /> )sa- � �� �� ) ❑ Site Plan drawn to scale <br /> and includes dimensions <br /> (City,Slat ,Zip�)J (City,State,Zip) <br /> M , r(0ft v_31.. 5�S7 2.... <br /> µ ❑ Site Plan including location <br /> PHONE PHONE Qf well/septic- <br /> tOCS Zlt C7S-1) <br /> E-MAIL ADDRESS II E-MAIL ADDRESS ❑ SetbaclCS ' <br /> MIv\hCJS�dr�n�o:heS� fn�^OJ•C0� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.chane.wi.us/) ❑==Site Pl a royal from <br /> PARENT PARCEL NUMBER: ZONING: }-{ ACREAGgE: -appkcabt nship. <br /> ❑ NUMBER U UV Z(t 9��U 6 ' ` -2- 5' / <br /> SECTION:1 <br /> 1--) ❑ ; Address <br /> 3nr1 € C1 Z i 1/4: ,,., /1/: ." (n ew •xietin4 <br /> ADDRESS:: <br /> y111- z,veS Q D`sA <br /> Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I Z° 9 ) _ Elevation of property <br /> PROPOSED PROJECT INFORMATION drawn to scale. <br /> PROJECT pESCRIPTION: <br /> '' )t x Z 0 Cot(1 F1'9'1 ❑. Drive permits <br /> . ❑This project is a new building or structure. (state, nty,town) <br /> This project is an addition/alten to an existing building or structure. 6< (-LSE.------ Sanitary:permits- <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> CCID °(public,,private)❑SEWER SEPTIC r^"" <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ❑ °Wetland/Floodplain/ <br /> 1 7 I Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑-ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 5C)4 ,. TOTAL SQUARE FOOTAGE: ;, . (etcPea,disturbance, " <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5 0 4) ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ,,� and available options. <br />- - (Please round to nearest dollar) 1 •-i O <br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LI No ❑Don't know <br /> 2.. There is a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project? -QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes ,a-No <br /> 5.,This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes J:-.1-No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes �No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —o- <br /> 545-112(1/08) <br />