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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER AME. / <br /> ,iii-30A/ kNi3 '"► LI SS 4 ,r' /V-Tn Zoning Status; CUP; <br /> OWN R ADDRESS (Number,Street,Ct�vv�.State,Zip) Deed Restriction;CSM / r'S 3 <br /> pa box 3o� f IA-rQm,/1J/e, k 5,5S:620 Variance(# L L.---- <br /> HOME PHONE CELL PHONE E-MAIL ADDRES •�3"742-7703 1,, /c l//.,, - c_c.r r Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME /� <br /> 0 Si location �(e' ° <br /> AGENT ADDRESS CONTRACTOR ADDRESS o weWseptic <br /> (City,State,Zip) (City,State,Zip) ®Setbacks 3 (D/2_51/K5-40 <br /> PHONE PHONE El Site Plan approval from <br /> applicable township. Jr <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> , :d Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property �� f <br /> PARENT PARCE NUUMBER:03_91524 CURRENTZONING: ACREAGE: <br /> 0 NUMBER b 3`9/0 t/O ta' p.. 1+ - S 31 Li frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> M/I-to/Wilk 1 10431404, j-7 1/a: 5■ 1/1/: SW ❑Driveway pe i <br /> ADDRESS: �, /�O te,coon ,town) <br /> 10-7 5s 4owpd -1 IL <br /> Sanitary <br /> CSM: LOT SUBDIVISION BLOCK/LOT Permits <br /> 2_c �as tS '- z <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW ' <br /> PROJECT DESCRIPTION: W �� <br /> N E N�M C� ST uc flo N $F zoning District <br /> t <br /> E This project is a new building or structure. ,Cv+ 6,- v(-- / pX " Pernitted'Use? c te-4 <br /> This project is an addition/alteration to an existing building or structure. 4,c <br /> SANITARY SERVICE: PERMIT NUMBER: kilikRuralAcid "• <br /> EWER jEPTIC ' '"'D i V-poo ■ O (new/= + • <br /> +w ) <br /> HEIGHT IN FEET 3 NUMBER OF STORIES: (Not including basement) W� ai <br /> 2 Shore land (attech enti /4 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: -`, �( 1ST FLOOR: distu ,/� <br /> !/'L(J ` 3 i 3 !� 4, TOTAL SQUARE FOOTAGE: 4, ESQ) <br /> 2ND FLOOR: 3RD FLOOR: , <br /> -4� I°2� if - <br /> , Location y . <br /> ESTIMATED CONSTRUCTION COST: an available options. /4-. <br /> (Please round to nearest dollar) -• ♦ ♦ ♦ -+ -, a8� � �l lV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ao 00on't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves ►i o ODon'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? QYes 'lo <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) QYes hz o DDon't know <br /> 7. Is this to correct a violation? [Yes 0 o <br /> 4 3--/ L ED APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -► -4. <br />