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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 ���pp <br /> , ∎t S t I tJ E- Fl D ER- n Z• oning Status; CUP; <br /> OWN�j ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> S O 8 MEnn4P+-1 IS E. Variance(# ) <br /> HOMEPHO{E 'IOW CELL PHONE E-MAIL ADDRESS <br /> 12(22S,0H/-- /OW ❑ S• ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA VIE CONTRACTOR NAME <br /> IVk ❑ Site Plan including location <br /> AGENT ADDRESS ( CONTRACTOR ADDRESS of well/septic <br /> a8 n't6 /Pk/s/*ii <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 44,A.01 S o 1k)/ W PHONE <br /> PHONE I ❑ Site Plan approval from <br /> Cd 9- / O q-01R67 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ F• loor plans to scale <br /> PROPERTY/LOCATION INFORMATION'' (http el/accessdane.co.danewi.usl) , ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL , , r 2 el.. / frontage drawn to scale. <br /> NUMBER O7/v G,-,7 _SC �. & !z- <br /> TOWNSHIP: SECTION: <br /> 1/4: h//1: ❑ Driveway permits <br /> ��iu+ �� � (state,county,town) <br /> ADDRESS: <br /> 30g- IV(ty frt.P'Li-S ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ` 'ST#1S REVI ,_. <br /> PROJECT DESCRIPTION: , - � <br /> (t`,. �i C (_.r ( G� < (t Ili o fln1,g SL F; ' " <br /> r,- 4 s=2.. <br /> . ❑This project is a new building or structure r°e4aa =. -,-, <br /> ❑This project is an addition/alteration to an existing building or structure. , :,, <br /> SANITARY S E: PERMIT NUMBER: °�Q r'.="� .-� -"'- <br /> ~ SEWER nSEPTIC 4€;-:Will g ! r t, <br /> HEIGHT IN j(� �(1/ NUMBER OF STORIES: (Not including basement) `tea' <br /> �i G�V VAet'_� �d�GOOD® �g <br /> AREA TO NEAREST SQUARE FOOT 'tea=, - 1, 7 L <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - tom`._: <br /> �""a eras,Q F �`��.'��a��;� <br /> BASEMENT: 1ST LOOq <br /> 1 " I j TOTAL SQUARE FOOTAGE: , 3 Ode ° r` , , <br /> ' 7 l� 3 ii 5 _ .t" : <br /> 2ND FLOOR: 3RD FLOOti/ / fbt, 5-I( /0. ",' <br /> ESTIMATED CONSTRUCTION COST m e F h c oli�e`�g ,- <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ �"-"'=_-,-- ""-= <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 ' Ato ❑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 INo ❑Don't know <br /> 7. Is this to correct a violation? ,'es ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - -I. <br /> 545-112(4/08) <br />