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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C -TOMER TO PROVIDE <br /> OWNER NAME ,, t,, ` <br /> VUncc- P - \ s _ Zo Ing Status; CUP; <br /> O NQER�A]DCD�RE SStrreet,City,State,Z rn 2�^�- D d Restriction; CSM <br /> H 1 PHONE CELL! / 1oJwe NE t7Q� 1 IC��N'`�i. �t�J V .ance(# ) <br /> 1 E-MAIL ADDRES <br /> 60 -8113--%S-V d1n loe, Eq. TO to Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jew /0436e,cc„0s S. e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 6e>r,°/ .f /ei,63E "awl' <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> ■l-,o.-'.0-. A,�1 S 37/!0 <br /> PHONE PHONE [I ite Plan proval from <br /> ..o�ZZ/-Yf`of p is etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> J Ale/Gu'°6 /Q70 e 7-Z5•A-Er F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of ert <br /> PARENT PARCEL L NUMBER: CURRE TZ• IN. ro• ACREAGE: p P <br /> ❑NUMBER 66/10-16/-8 ow-6 /9i / 1/97 frontage drawn cale. <br /> TOWNSHIP: SECTION: <br /> P .i . ,�/E,/4,/. ❑ Drivewa ermits <br /> ADDRESS: <br /> !/ ,/4 (state ounty :,rn) <br /> 2979 /WWI i I. • McFac(A i k 53SS� ❑S. ita permits <br /> CSM: �� LOT SUBDIVISION BLOCK/LOT (. b private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ( /' <br /> c' 1D S Y ?C a2 2 ■ . oning District <br /> . S.This project is a new building or structure. ermitted e? <br /> ❑This project is an addition/ teration to an existing building or s(ru to e. /Vi <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural ,ddress <br /> FIEWER EPTIC �/ (new'-xiStin• <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ct Fea -rail,. 1 ❑ Wetland/F odplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorel d (attach t) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> 1STFLOOR: ❑ ErosionCon '•I permit <br /> 1 TOTAL SQUARE FOOTAGE: j (slopes, .. turbance, <br /> eeRr See-Fteeft. 38 filling/access) . /i.)b) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ♦ ♦ Q� 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? ElYes 'lo ❑Don't know <br /> ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Yes FNo ❑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 ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ,®No <br /> II iii, <br /> 1 APPLICATION MUST BE SIGNED <br /> 545-112 1408) - .1 (Continue on Back) -► <br />