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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 /> �j 1 @ _. I esv 1 g ' L_;66( r <br /> 0.i Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) <br /> .1 Deed Restriction; CSM Y v i � I G-VY,S 1 Or Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> fag— OO 35311 .48 _11 go • ,S. ._aoo3 Q dc.. t..t0 IS Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME ' CONTRACTOR NAME A. <br /> N r"T ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> NUMBER 04 610611-; %- o IR 3—DCPRU.- i frontage drawn to scale. <br /> TOWNSHIP SECTION: CG0:-,-Gg351 <br /> Fl e0.citky,f y i' h /- a ci 1/4: (0 1/41/4: l I ❑Driveway permits <br /> ADDRESS: / ✓ � (state, county,town) <br /> D 7 o p W ( I ' ;a r's/ )9Y- ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> OC,\IDq I8(o3010 N riI) (public,private) <br /> PROPOSED PROJECT INFORMATION g A/ j <br /> PROJECT DESCRIPTION: %"v����� :/ /j ,��� j/ <br /> )9bh-,ems; ( row I E.Yc)6JtiYp P.1'i')-1;1 A ' , ,�: ; <br /> . gThis project is a new building or structure. 0 //,�o j/ <br /> This project is an addition/alteration to an existing building or structure. �,,,/�/i�, /,��i/�j�///; <br /> SANITARY SERVI E: PERMIT NUMBER: ° . %'er <br /> EWER [EPTIC s/ § y / `� ij% 4 <br /> HEIGHT IN FE T: R7" .t,g NUMBER OF STORIES: (Not including basement) > i / �:,4,0 �� . <br /> °y :</4t$41. / <br /> 8, 1 s iii, <br /> E <br /> AREA TO NEAREST SQUARE FOOT: j///i,/ / �,/, �, //jj <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ,/ �� �, / „//% <br /> BASEMENT: 1ST FLOOR: :%1:' /; �i j% <br /> t0 4, TOTAL SQUARE FOOTAGE 4, /i//., a " / / <br /> ii/i /iii/ / // <br /> 2ND FLOOR: 3RD FLOOR: m4 r// y %/A/ / /�/i <br /> ESTIMATED CONSTRUCTION COST: r ',. f <br /> (Please round to nearest dollar) ♦ ♦ ♦ aGO,� tt ,%','' jj//„%o,��;//j:„%% „j/j„ <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 ENo ®Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes El 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 ❑No ['Don't know <br /> 7. Is this to correct a violation? Elves ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -* -* <br /> 545-112(4/08) <br />