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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 (7 Lr a .t )-t3ce., , I L G oe v o JJ e r Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM / 11t- r<( <br /> 403 ti--ks* Vc,l(,e 1 . k- J c J ton , Ci t S 3 SZo z <br /> Variance(# ) '-f-a,u-c_ <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS ^ 70� <br /> I0UB 633 `445� ta66- Zl 1-2010 Vte/r5h 5.�' c" r>^o�.l'(-on-- ❑Site Plan drawn to scale s <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ 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-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> UMB <br /> PARENT PARCEL NUMBER: CURRENTAONING: ACREAGE: <br /> ❑NER 0 a 3 Z3 — ?iOO-O /(14—/ Z- , 6 3 6 frontage drawn to scale. <br /> TOWNSHIP: / SECTION: <br /> t e f- 0 , 3 2_ 14: 5 //: 1,/- Driveway , <br /> � <br /> (state,county ow <br /> ADDRESS: <br /> // Z / /4 7-Ow,, ea <br /> CSM: /� ( LOT SUBDIVISION BLOCK/LOT A Sanita •- "its <br /> (publi M <br /> / <br /> PROPOSED PROJECT <br /> INFORMATION STAFF REVIEW <br /> PR C E P OS � / ? D / CB - V e LD og Dsc <br /> /G� f rs L i i <br /> . <br /> This project is a new building or structure.��6 c7-o r$ 6 c.-r c Vs ,e C� `� <br /> i S ,,` 5..e ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structures,f r.c w 6‘,4 1''� - <br /> SANITARY SERVICE: PERMIT NUMBER: 1�/ ,' 9.-CL/ Rural Address <br /> FIEWER [)EPTIC�,I ' i'✓L +42 (neW/existing) <br /> HEIGHT IN FEET: ,.,\■ NUMBER OF STORIES: (Not including basement) <br /> LI Wetland/Floodpiain/ <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: 1ST FLOOR: <br /> _ _ ❑ ErosionControl permit <br /> (> ,, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: _ 00 ❑ Review Location Survey <br /> ESTIMATED <br /> CONSTRUCTION COST: -0 ♦ -4. ♦ ♦ ♦ $ iii © ©D, ©o and available options. <br /> (Please round o nea es dollar) / <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 nNo ❑Don'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? ... ❑Yes , No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#�7 D 3 ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) ❑Yes As ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes EI`o <br /> /Vô 1 / 0 s c, 3a <br /> APPLICATION MUST BE SIGNED <br /> 1 (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />