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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 /> Ct IA '5'nS�1 6 1-2"-P\ ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Nniber,tireRc Cit State,zip) Deed Restriction; CSM <br /> /e.©/ ` 0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7--2-O ---i790-2- /S o, Mt—t/ <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG <<NA�M� %Zt�1�vJ© CONTRACTOR NAME <br /> /sari-45-0-A3 O ,t <br /> )^ v'1' '1-5' ❑ Site Plan including location <br /> AGENT D DRESS /\ / Rs CONTRACTOR ADDRESS of well/septic <br /> (City,State, <br /> yl City, Sh Q 1/ Cj (�� (city,State,Zip) 5.� ❑ Setbacks <br /> PHO /)g 9 21-7-56'JY PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS /� E-MAIL ADDRESS <br /> , yt.`k z/'7 6 q i% /3 41 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRE T ACREAGE: <br /> 1=1 NUMBER ow 3 j I 8. 0 J frontage drawn to scale. <br /> TOWNSH ) J � SECTION: <br /> ( 4 ti'i ST) �_ ,/4: ,/4,/4: ❑ Driveway permits <br /> ADDRES�� / n / (state,county,town) <br /> a ( ,B (/V <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> / .r-----_ (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: r^ J� ,� <br /> (5--a i'R y C- d) . a'f c— k t)vt'51)v S I koL'0,0 Zoning std, <br /> . ❑This project is a new building or structure. <br /> 4:permitted Use? <br /> SANI This project is an addition/alteration to an existing building or structure. a <br /> TARY SERVICE: PERMIT NUMBER: A _ ', s I it <br /> SEWER SEPTIC <br /> Iexi�) 4' , <br /> HEIGHT IN FEE NUMBER OF STORIES: (Not including basement) = ` -- <br /> Z Z UWe q.: <br /> AREA TO NEAREST SQUARE FOOT: �� C ;41'4110 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) : j o,',4,:',' <br /> BASEMENT: 1ST FLOOR: r?� 4-, �tr <br /> 4, TOTAL SQUARE FOOTAGE: 4, ��I'I ..,dtstUr Ce, <br /> ' hiVar4sts <br /> 2ND FLOOR: -1?V 3RD FLOOR: 4140- / 7 44, - ' ' '47,,,,It, , <br /> 0,11tOyipw Location'survey:, <br /> ESTIMATED CONSTRUCTION COST: 6 y; �(3 <br /> (Please round to nearest dollar) ♦ '♦ ♦ ♦ ♦ ♦ r ©r �� , ; : l , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes grNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,N No ❑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) ♦ - -. <br /> 545-112(4/08) <br />