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SUPPLEMENT to Web-App is <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 10.. �uw LJ. G^rrk?rlswL tRiZoning Status:CUP. A / <br /> OWNER ADDRESS(Neater,%vet Cry,Slob,Zip) Deed Restriction:CSM <br /> 6 7$ T• . i( .Su..P-4-r e (J 11 .53590 Varian: • ) <br /> HOME PHONE IT E-MAIL ADDRESS <br /> /11 t <br /> .rAin s••., al a "'r^•�•rO"'r �Sit Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan includin.I..._'.. <br /> AGENT ADDRESS CONTRACTOR ADORESS .lYn•. <br /> (City,State.Zip) (CM,Sate.zip) ❑Setbacks <br /> PHONE PHONE — /Site Plan approval from /,I <br /> K township. L31- <br /> E-MNL ADDRESS E-MAIL ADDRESS <br /> 12 Floor plans to scale . <br /> if <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.usi) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING' ACREAGE: <br /> NUMBEER 09(I-3.,I-6381-3 A-I /. 32.7 frontage drawn to scale. <br /> TOWNSHIP. SECTION- <br /> 8 _ <br /> r j sip 1 3 y.: 5 L Y..y.: NI r Driveway pe <br /> ADDRESS: (state,count,town) <br /> 6 7 BY 17r63.. 72411 "Sanitary <br /> csM. LOT SUBDIVISION BLOCK/LOT (put). private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW ( <br /> PROJECT DESCRIPTION. <br /> Dec-k Zoning District �/,`-o y!'� <br /> . QThis project is a new building or structure. Permitted Use? O C S! E <br /> This project is an addition/alteration to an existing building or structure. 4- ' c —of f.\^c <br /> SANITARY SERVICE: PERMIT NUMBER: Rural A <br /> EWER �EPnc (ne existing)) `�O <br /> HEIGHT IN FEET ///""" NUMBER OF STORIES: (NG ildu6np Writs) /y 5 F� <br /> (p I Wetlend/Floodplain/ G//,j.. <br /> AREA TO NEAREST SQUARE FOOT. Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and • .grade <br /> BASEMENT 1ST FLOOR <br /> ) (slopes,disturbance,ante,permit �fp �/ <br /> 3 y y j TOTALSQUAR[FOOTAOI:+ (slopes,disturbance, D ,fit <br /> fillin access <br /> 2ND FLOOR 3RD FLOOR: // <br /> ESTIMATED CONSTRUCTION COST: S a ❑Review Location onions. <br /> (Please round to nearest dollar) $/_ 000. and available options. <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes o DDon't know <br /> 2.Is there a wetland or floodplain on or near the property? [Wes o [Don't know <br /> 3.Have you talked with the township about your project and are they in agreement? es o <br /> 4.Has there been a zoning permit issued for this property in the past 5 years? []Yes Jo <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 Olo ODon't know <br /> 7.Is this to correct a violation? Q1'es o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -, -e -s. <br /> 545.112,AN8/ <br />