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SUPPLEMENT to Web-APP # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTO ER TO PROVIDE <br /> OWNER NAME J <br /> Rw�1-0-vx pv-V'e oning Status; CUP; <br /> OWNERADDRRESSc umber,Street,Ci ,State,Zip) Deed Restriction; CSM <br /> �� IQ�.v- Y)1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> qn�/S -Ptah drawn to scale <br /> AGENT INFORMATION CONTRACTOR-INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site I including location <br /> AGENT ADDRESS CONTRACTOR AD ESS of�eptic <br /> (City,State,Zip) [LJA <br /> (city,State,zip) �l etbacks <br /> % _ - <br /> PHONE PHONE <br /> n proval from <br /> ap a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F(rplans to scale <br /> PROPERTY/LOCATION INFORMATION-::(http://accessdane.Co.dane.wi.us/) : vation of property <br /> ❑NUMBER C)6 IC) - I rontage drawn to scale. <br /> TOWNSHIP: ��a SECTION: <br /> '/a: '/a'/a: ❑ Drive rmits <br /> n (stat , unty,town) <br /> S /..._. N_is.4_ ✓ ❑Sanit ermits <br /> CSM: LOT SUBDIVISION BLOCK/ ST <br /> fus4;1Ri'd' i ' (pub' , rivate) <br /> PROPOSED PROJECT INFORMATION e_INFORMATION e..j n5 s Roof. f�`�-G� j .:,......, <br /> L'I•, ►a�Ow g c'vJ. c T" �f c� �'iS7� C'nC�C�� 011ing DIStf Ct " <br /> . ❑This project is a new building or structure. P mlttedUse? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural Address <br /> }`1 EWEREPTtC V ne`� / / ng <br /> HEIGHT IN FE NUMBER OF STORIES: (N including basement) <br /> � _ L - etland/Floodplaln/ <br /> . °O ttachment) .. <br /> } <br /> AREA TO NEAREST SQUARE FOOT: 0 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '<� 4rP = 0 <br /> „❑ EroslonpQntrol •errnl <br /> BASEMENT: 1ST FLOOR: r <br /> I 1 TOTAL SQUARE FOOTAGE y ` 1 0pses .b isturbanc..:74::_,,,,,,,,,,,,,,...:, F� <br /> o I oTacces <br /> 2ND FLOOR: 3RD FLOOR: J g 4` : 1.0ik9a :I <br /> y L Re eW "c Inn;Survey:.. .. <br /> ESTIMATED CONSTRUCTION COST: $ , ,ane v • options <br /> (Please round to nearest dollar) _o. '� ♦ ♦ '� �'� J <br /> C <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 allo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4.-Has there been a zoning permit issued for this property in the past 5 years? DYes ONo <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 fNo ❑Don't know <br /> 7. Is this to correct a violation? Elves ['No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -11. -► <br /> 545-112 14/08) <br />