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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 /> a—� <br /> 1 � A Et.. L Au , l�G ['Zonin S atus; CUP; <br /> WNERA DRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3137 1-4 Gti 7I N 04 i JleeS W:j- S�3 S'7 2 Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL ADDRESS <br /> 31` ' O' 4O P-14 . _ CusTDm'i & )'A/IDO,c001 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR_INFORMATION - and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> V(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:I/accessdane.co.dane.wi.us/)_ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ElPARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: „ �eway permits <br /> C3LJ c k ETA r4: 1/41/1: <br /> ADDRESS: 'estate, county,town) <br /> S 5 Co Nwy BI.ACVJ €c Rf'/4 tNr 3 /c M<anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Qb RC N.\ ZonIng DsncT lt lailiit- <br /> . ❑This project is a new building or structure. ermitted;Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: RUral Address <br /> [EWER it EPTIC - ne11StIng) )4:eC{■: o <br /> HEIGHT IN FEET: ) NUMBER OF STORIES: (Not including basement) rl� <br /> i Wetland/Floodplaln/ <br /> Shoreland ( ttachment) 5 <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 /> Eroslonntrl CQo permit <br /> •.71-1 4 TOTAL SQUARE FOOTAGE. 4 `(scopes disturbance, <br /> II',ng accets, - 't; <br /> 2ND FLOOR: 3RD FLOOR: i"i A ;-0;w .:; <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q /� and available options <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ 'P 1.,J00 1t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves QNo ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies QNo <br /> 4.'Has there been a zoning permit issued for this property in the past 5 years? fires 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) Elves QNo ❑Don't know <br /> 7. Is this to correct a violation? Eyes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0 -0 <br /> 545-112(4/08) <br />