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. <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Va."/- i i VIC Brady ►:4 Zoning Status;CUP; A -1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) c '� Deed Restriction;CSM <br /> a?�� arch wy/Qde Pa33.4,- e_ — 4vt f t'Llire LJ,� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A I DRESS <br /> g3 ' (P9/9 0Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> f <br /> AGENT NAME CONTR• TOR NAME C Z 3 <br /> � <br /> e "c}} i tZc 11 rt lt - 'ding locatio <br /> '-I AGENT ADDRESS CONTRACTOR ADDRESS O _ <br /> i <br /> 5:2•6 CO✓Y)//1erCirt. :V' '' -/ <br /> (City,State,Zip) '�✓-al%�� �i�• /0//0 <br /> (City,State,Zip) Z.. ►�� Setbacks <br /> --� IM I1/f''ie 1421— _57.3s- <br /> PHONE �p <br /> PHONE / 0-Site Plan approval from N� <br /> FS..7- 63/,2 applicable to pship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Qda01.zi.....,e.-,,,,,,.,&jer„+,.,.;$0,,at wo' ,o1.1 ' oor plans to scale 4 <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usQ ,r Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y 23`� <br /> E]PARCEL NUMBER 01 2 •' -•e drawn tp_ssa+t. ?5- 1 <br /> TOWNSHIP: SECTION ,/ �j , <br /> �( S.t OC ,5 i- 1 1/4: /"1 0 '/4'/4: Vl/ IM/—�DDnveway permi <br /> (state,county, • <br /> ADDRESS: j� <br /> 01'7e4 2 ora-11 'a5.S le Sanitary.- 'sits <br /> CSM: LOT SUBDIVISI N BLOCK/LOT <br /> / (publi.,private <br /> �Th `t Dr'-!1 W' vipi e <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: I/ jjJT <br /> K.i}-Ck e vt add j+■pet koning District /� <br /> ❑This project is a new building or structure. <br /> K p ,9 i Permitted Use? // 1� s rit <br /> This project is an addition/alteration to an existing building or structure. A{' 'T�� <br /> SANITARY SERVICE: PERMIT NUMBER: 541 Rural A.,•■•-i. <br /> EWER EPTIC /// ��\ (new/r isting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> (' ' Wetland/Floodplain/ A/74.. <br /> Shoreland (attachment) / �T <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached ga,ages and above grade decks or porches) Al ErosionControl permit <br /> BASEMENT: 1ST FLOOR: r <br /> �l�J j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, ,�1/t <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> Review Location Survey,AV <br /> ESTIMATED CONSTRUCTION COST: ♦ -► and available options. /l/ <br /> (Please round to nearest dollar) $ �6 GYRO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eyes Flo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? [Y s 'No ['Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement? 1'es ❑ o <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? Eyes No <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes El No ❑Don't know <br /> 7. Is this to correct a violation? Eves I o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► --► <br /> 545-112(4/08) <br />