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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,c1n oning Status;CUP; <br /> �WN R ADD ESS (Number St City.State.Zip) Deed Restriction;CSM <br /> �1)� alto t, IJavL-P�Li,i�rle �C,-�(1CjWL 5 57g Variance(# ) <br /> y40ME PHONE ;CELL PI'ONE E-MAILADDRESS <br /> 11•- °, —0• de Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl des dimensions <br /> AGENT NAME CONTRACTOR NAME , <br /> SGl YHQ Q S (� ►�.Q�1/ <br /> Win C on cb m I ) ( ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic CA3 <br /> 1� �t, ste�n <br /> City,State,Zip) (City,Slate,Zip) backs ' (15, <br /> P,.-. a #. A 53c4 I <br /> PHONE PHONE 0 Sit PI pproval from <br /> Lit g' 2. -"7 2 O a I. I ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS I <br /> •ro A I. 11 ' • ' V 61411 C6 D-F‘plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: @Nation of property <br /> UM <br /> El NUMBER o CM 1% tot -I R <br /> 3D ' tiS �j , 5 5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> / O bO 1% '/4: '/'/4: :Driveway per " a, O <br /> v ADDRESS: J (state,coup ow /� <br /> CSM: OT A� SUBDIVISION BLOCK/LOT anitary • ■ its ^'t <br /> 22 (publi•tTt_. .-�\ <br /> PROPOSED PROJECT INFORMATION /STAFF REVIEW • ( <br /> PROJECT DESCRIPTION: <br /> \ <br /> Now Cwv/ C.OY‘SkI-yJ tY, S'/-A WZoning District <br /> This project is a new building or structure. CpPefitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. 3 bet mi. <br /> SANITARY SERVICE: PERMIT N MBER: 7 r- Address <br /> [EWER EPTIC �S4 /�-- 11 1Z/0 , .� 11;xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 'L-0 , /� i • ,, ;- 1./Fl•..': slain/ <br /> r l S •.- : • -ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �l ❑ Erosio •• , •I permit <br /> t Cl�cj ` ).. . TOTAL SQUARE FOOTAGE: , (slope •I rbance, <br /> 2ND FLOOR: "i 3RD FLOOR: <br /> fill',• access) <br /> 7rAtrn179\S-Q <br /> "V 'evie L n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and a 1@ options. <br /> (Please round to nearest dollar) $ 2_`I g t 0 c O <br /> V /14 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes 'lo :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes go :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes ao <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 [ lo :Don't know <br /> 7. Is this to correct a violation? :Yes 13Nlo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i -1 -► <br />