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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 /> • <br /> SIR 1 ln //444.�vr. ❑ Zoning Status; CUP; <br /> ADDRESS (Number,Street,City,S e,Zip) /? Deed Restriction; CSM <br /> �a 5)')'11 k- ern r1F' �— Variance(# ) <br /> HOME PHuNE CELL PHONE E-MAIL ADDRESS <br /> a��o�S-/ v <br /> El Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C ,7. (,.4s ,,.,,, w nst_ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE /NE�te[� � 3j ❑ Site Plan approval from <br /> 6',0 3S- t7Ss applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS e_c� �� c t,,,i,,� 6�,�,,, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARC NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER 41111 p�,la�l(0a—g3oV` ( A-J (1,75— frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ❑ Driveway permits c; n( ) /:6, '1 5„, //4. L <br /> ADDRESS: (state,county,town) <br /> C5201 5 r N . . rC9 LYY\1 („ lJ� 3�0� ❑ Sanitary permits <br /> CSM: LOT SUBDI ION BLOCK/LO <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , <br /> 3o, ? �•` '0010� <br /> C Itt.r4 <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: El Rura •° <br /> nSEWER „SEPTIC {new:10.0:,,s11110); <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) �4 <br /> etls' F ° <br /> r�r Et and (Attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: <br /> 1 (� C'�0 4, TOTAL SQUARE FOOTAGE: 4, + ' I+', Urba . oc <br /> J Li . <br /> 2ND FLOOR: 3RD FLOOR: „f. '/ ; <br /> /`S^O dw Location Survey.• <br /> ESTIMATED CONSTRUCTION COST: $ <br /> (Please round to nearest dollar) ♦ ♦ ♦ .4. .+ —• �l ,,, <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there 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 and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> El 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 />