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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 /> I"t� i S -1 eLc 'Brady ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> a74/?-- /W�ori-h WyAde as 9e. a <br /> vt f/ ire7 GJ= Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL A DRESS <br /> S — (OW 9 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONNT•• TOR NAME <br /> evul.in s t Wok+ ' crsie ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic•5 e.0 Com ere 4I`L ' e r!_e/-/.-/% ' <br /> (City,State,Zip) (City,Star,Zip) • Setbacks <br /> $AI1 /aioie/ WE 33.5-20 <br /> PHONE PHONE ❑Site Plan approval from <br /> :37_ 63/.2. applicable township. <br /> E-MAIL ADDRESS E-MAIL As DRESS n <br /> Qdawt.2;w»•e .•@ ja.m...,.tis Q wa)011( j-1 Floor plans to scale <br /> coal.. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: ❑Elevation of property <br /> PARCEL _ LAG} frontage drawn to scale. <br /> NUMBER 0«1ORN-29)--Zar-y ( e ! /S <br /> TOWNSHIP: SECTIO : <br /> Tavt 04' S 4j i '/a: /4�/4: ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: j� <br /> ca7yOZ or twyvide- ,Q5 se_ LI Sanitary permits <br /> CSM: LOT 45— SUBDIVI ION BLOCK/LOT <br /> or h w l e (public,private) <br /> PROPOSED PROJECT INFORMATION �O` STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> � <br /> i+Cne v1 k/i+;peg ❑ Zoning District <br /> ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> Xhis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWEREPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: LBI ST FLOOR: r—, <br /> ErosionControl permit <br /> 1 + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: l ( filling/access) <br /> `� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION)COST: ♦ ♦ -► ♦ -► ��` and available options. <br /> (Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Peso ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Y sNo ❑Don't know <br /> 3. Have you talked with the township about your prof ct and are they in agreement? Yes ❑ o <br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? Des 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) Lives 1131 o EDon't know <br /> 7. Is this to correct a violation? ❑Yes M o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► -* <br />