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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 /> f'e X 7' \TZ 'f0 ['Zoning Status;CUP; <br /> OWNER ADDRESS (Number.Street,City,State,Zip) Deed Restriction;CSM <br /> 3W1 C 1 /] / 7/4,4k Eai Ih wf 5151 S variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> e6g-or5-g-%57 as • L, , ;c.ihe. wise.ed1A n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM <br /> art 'OW I,3 i $ Ar i t ,�,'- ,Z ❑Site Plan including location <br /> AGENT ADDRESS rh t / CONTRACTOR ADDRESS of well/septic <br /> a L{ 50' S'f El Setbacks <br /> (City,State,Zip /+ t�I (City,State,Zip) <br /> ,,l (a 'e W ' J `t <br /> PHONE PHONE ❑Site Plan approval from <br /> .71. - g-2LJ Loo �1u_335=53 a- applicable township. <br /> E-MAIL ADDRESS t E-MAIL ADDRESS Floor plans to scale <br /> `,C Fr , ' nOrk\ u10k1Z VI� I OOr <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: [' Elevation <br /> drawn to scale. <br /> QPARCEL 07©(a0lag5$10 5, -ia7 <br /> NUMBER <br /> TOWNSHIP: SECTION: Driveway pel ITtItS <br /> �er ,.�o '�' 1/41/4: (state,county,town) <br /> ADDRESS: <br /> a-' Cy /L 3 13k k {k Wt 5-. 575- Q Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRlPT10N: 35)(5&��_/ 1 t <br /> � <br /> . El This project is a new building or structure. <br /> OThis project is art addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ��, <br /> FIEWER PEPTIC <br /> HEIGHT IN FEET: �� I NUMBER OF STORIES: (Not including basement) <br /> 1 <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 /> j j TOTAL SQUARE FOOTAGE: , <br /> 2ND FLOOR: 3RD FLOOR: A,/6 90 s7 p-i- . <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► ,♦ ♦ II DD <br /> (Please round to nearest dollar) I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes Do ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ElYes ao ['Don't know. <br /> 3. Have you talked with the township about your project and are they in agreement? QC Yes Qnlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? fYes lalo <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 a° ['Don't know <br /> 7. Is this to correct a violation? ['Yes Oslo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0 —► - <br /> 545-112(4/08) <br />