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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 /> 1/40-i' y e- 4' I¢r'en /do,f/a-4-1 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> /oya Tyr/or 4/1 , 54,04 4.Aohi W/ 535 Variance(# 3C -a- ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> kot-873-33V 608 279-6833 N1141 VII Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT AME CONTRACTOR NAME �- <br /> P ea I [Site Plan including location <br /> AGEN ADD Es ( CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zi)i (City,State,Zip) etbackS <br /> PHONE PHONE D-Sq-e—Plan approval from <br /> 0,1, = 7/07 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> T S— v ,C4 loot plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) nevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ' ►'_ p p y <br /> ❑ PARCEL may/ /7/_o2m/o6-r k Q, 6 6 7 frontage drawn to scale. <br /> NUMBER ",+ <br /> TOWNSHIP: SECTION: <br /> baNkfter /7 1/4: NW '/4'/4: N r ❑ Drivew ermits <br /> I-ADDRESS: (Sta ,CO nty,town) <br /> Jo - r4Y.con IiI, SToct.&I/- oA, W/ <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanita rmltS l <br /> 33 7 3 / RI'E,euboP £ 7,4EES 5-' (P c, vate) l�l � <br /> PROPOSED PROJECT INFORMATION IEW <br /> PROJECT DESCRIPTION: ya <br /> � fcIt �► Res Q ids -; • . <br /> This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. jH - l� <br /> ;: , X <br /> SANITARY SERVICE: PERMIT NUMBER: r , , <br /> nSEWER SEPTIC , <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) ;Ta <br /> '� / <br /> AREA TO NEAREST SQUARE FOOT: .,* ' spy-: f <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` <br /> 3 � 4 ® f� �x°� <br /> BASEMENT: 1ST FLOOR: ' . �- ,,AU <br /> )S c () 4, TOTAL SQUARE FOOTAGE: .g � . a <br /> 2ND FLOOR: 3RD FLOOR: / y n 10 - , <br /> I c a ' � <br /> .. <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ UO ,4, <br /> (Please round to nearest dollar) 1 U,a CQ i <br /> e -., <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NI No ❑Don't know S <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes MNo El Don't know „Ob <br /> 3. Have you talked with the township about your project and are they in agreement? E Yes No , _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IgNo <br /> + ' <br /> 5. Is this project associated with a rezone/CUP - (petition -ppea • 7 O7 Z) (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 121No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -► <br /> 545-112(4/08) <br />