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;SUPPLEMENT to Web App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> •PROPERTY-GINNER INFORMATION i , , _ ' F.,:' CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> cr�W4LO S. C:1210(4 1_1 L. - <br /> OWNER ADDRESS (Number,Street,City,State,Zip) El Zoning Status; CUP; <br /> 2 yg 3 IyTt_L r-/.4fV►S 0 R, 576x6 �-F T-"- 141± S'� G Deed Restriction; CSM <br /> - s 8 � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> li/4- 608, 209 . 8Y 4l3 A- u'FP4C >=Rs��N (2 V411"' te,•, ❑ Site Plan drawn to scale <br /> AGENT tINFORMATION _ '. <br /> -s„„3 . ,CONTRACTOR INFORIIIIATIONz• _ .'4 _% 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 INFORMAT1ONP`(httpa/accessdane�co,dane.wi.us/) • , ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL o C!o[t_ 7'-_g? /0-Q r� H _ L z . 499 frontage drawn to scale. <br /> NUMBER `�� <br /> TOWNSHIP: SECTION: <br /> P F S-P0_ G-S 1 7 '/4: I� Y4,/: SE ❑ Driveway permits <br /> I ' (state, county, town) <br /> ADDRESS: <br /> ”2-L 1 3 3 w L L T i k fr►S 02, $ 6V G-14-7-4 J (,jJ- ST?c y ❑Sanitary permits <br /> CSM: t 0 974 c5 6S/ LOT SUBDIVISION BLOCK/LOT (public, private) <br /> 3 364 33 -2 q zap'. I <br /> PROPOSED PROJECT INFORMATION - = STAFrREVI_EW <br /> PROJECT DESCRIPTION: r 4 t- m ` <br /> r <br /> 16 I X 16 I ()EC K 'Zoning Dlsfractit s <br /> This project is a new building or structure. '0 1?ermfted'Uth7 <br /> [1]This project is an addition/alteration to an existing building or structure. _ �� f <br /> © Rural Address~ i <br /> SANITARY SERVICE: PERMIT NUMBER: � � , ? <br /> EWER �EPTIC �� � ` <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) ” ,- } al . <br /> 3. Q Wetlanc/ lood lath/ <br /> Shoce1and' attach.mettt) <br /> AREA TO NEAREST SQUARE FOOT t� -F L <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t -_. <br /> BASEMENT 1ST FLOOR: C� E fos1oriC-onr.�l permit <br /> TOTAL SQUARE FOOTAGE t` a1opes&d turbance, i f <br /> . . . . tflrlri access ` 4 • <br /> 2ND FLOOR: 3RD FLOOR: r{4 q z 3 :f *` �' <br /> Z�� 0 Revtevif_L`ooatjon Survey _ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► -o. 6 arid.a'a�ablez pttortS, <br /> (Please round to nearest dollar) 2/ Odd L ftj i x <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [1No • ❑Don't_know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes EN.0 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? []Yes ENO <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 Erko EDon't know <br /> 7. Is this to correct a violation? Eves Q I <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112{4109) <br />