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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 /> (A)\ L I-I Am G LEAVE ❑ Zoning Status; CUP; <br /> vDWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /� <br /> 517 N . EvER ITT PALIgTINE IL Goerr-i Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 63- 878.000S b'den - lom 'S• corn ❑ Site Plan drawn to scale <br /> AGENT INFORMATION - CONTRACTOR INFORMATION - and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C1-'c'' Nev in a et r ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3185 Geer PO4 Or <br /> �City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> &to�►alln-\-o v LJ S3S89 <br /> ���/// PHONE PHONE ❑ Site Plan approval from <br /> 60S - 817 --( 1 3 I applicable township. <br /> E-M AILADDRESS E-MAILADDRESS <br /> kr i S • 51-10 w .u,I 1 2,rS.co ❑ Floor plans to scale <br /> PROPERTY/LOCATION:INFORMATION (http l/accessdane co.dane.wi us!) 1_1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL I 2 frontage drawn to scale. <br /> NUMBER 0610 -O9a-600/-44 !\� 2Z. <br /> TOWNSHIP: SECTION: <br /> 00 N ❑ Driveway permits <br /> 9 '/<: ►.)W '/'/a: SE (state,county,town) <br /> /ADDRESS: <br /> 1/ 791 (A!/LLOW CT A ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION oo p BLOCK/LOT (public,private) <br /> GrPRn h;A • fork I I <br /> PROPOSED PROJECT INFORMATION _ <br /> i:STK j REVIEW r <br /> PROJECT DESCRIPTION: '� ' - <br /> NEW 40 PAL D `� '� 1 <br /> This project is a new building or structure. , -,aQ - ®" <br /> ❑This project is an addition/alteration to an existing building or structure. ��n --,, i, �.tr4, <br /> SANITARY SERVICE: PERMIT NUMBER: a XIS <br /> EWER nSEPTIC � �s ,i- �. 1- .. <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) _ -awry` <br /> a0'-1'' A - N "fi°°`�� _ <br /> -�S �S I <br /> '-.ii a ore aE1,!. <br /> AREA TO NEAREST SQUARE FOOT: "' . t•h_ ... <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) Y4 ' ,, <br /> BASEMENT: �'Qqw� 5PAGE' 1ST FLOOR: :� -� - i.1 .: r;z: <br /> /L/a ,),Li 0 4.3 y 0 4, TOTAL SQUARE FOOTAGE: �� 6 ° °; --Z <br /> o�g J t s e�r.;_,.._ _ �1S <br /> 2ND FLOOR: 3RD FLOOR: ,LL „,!_ tit <br /> ESTIMATED CONSTRUCTION COST: fi00] ®o s >� <br /> (Please round to nearest dollar) -* -+ -* .- ♦ -* $ p`S't/ ado, O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? JYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? )Yes LJ No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ZrYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 21-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) ,aYes El No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes E'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />