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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 /> C1 a t-- K q--- eh 4 ,-Pe,� ''`'e`t ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,St e, iP) Deed Restriction; CSM tzw A P/ONE 1 a N�CE�PHONE S MAeAli ESS (.L) �5 7 Varl Ce( ) <br /> 6c _3 L 6-5-1,/, AA 6Lo&vp70 to ; 5c , eJu e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME COO,TRACTpR NAME <br /> v � ^ /A K I 1-3.t r /\ 0 I V I'e<-0 (6111 (- 0 Site ' - ., uding location <br /> AGENT'ADDRESS p CONTRACTOR ADDRESS of ,- e c is <br /> 78 tit) L eat,) /l4. `i✓7 / --/;-,.,t,, I, Sf <br /> (City,State,Zip) (City,State,Zip) al Setbacks <br /> tA;� 0 Cp.t k (VI" S `1, -41i( M c FAL, (,�1, d 1.0.E .;3537 <br /> PHONE PHONE ❑ Site ' : -•proval from <br /> —7 15 - 'q g- ` 09, ) L ! 4 o g —' 3g 0 ? 6-7 appli -. e •wnship. <br /> E-MAILADDRESS E-MAILADDRESS /, <br /> • D 0 ' m`t' - 6.6 N ro© /< iVi mow- C.OH'► oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.drane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> El rPiuMBER oG// --?1-1 (S'a! 0 0 K— frontage drawn to scale. <br /> TOWNSHIP: CC SECTION: <br /> fI-e4gan -(' J6pv-ini 4 3�- . 4: 3jw '/4'/4: re . El Drive ermits <br /> •ADDRESS: <br /> (state nty,town) <br /> 02 7/1" Y h et i-- k J ❑ Sanit-'1 • -rmits <br /> CSM: LOT SUBDIVISION ,�LOCK/LOT <br /> J.�S�� (publ.• . ivate) <br /> PROPOSED PROJECT INFORMATION FF REVIEW <br /> PROJECT DESCRIPTION: (�dd ‘6,,,, ev,,Lr. 1S'1 p e4k- D r`O4S� 31 5,-et 1 <br /> ,22„) ning istrlct .' <br /> . ❑This project is a new building or structure. Pe fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT N BER: Q Ural Address .. <br /> EWER �EPTIC (nw/ sting) <br /> HEIGHT IN FEET: NUMBER OF STO ES: (Not including basement <br /> v t 3� / / (• 5 e 1 e v g�e�� Wetland/Floodplaln/-,= <br /> AREA TO NEAREST SQUARE FOOT: Ore an• achment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> E[0$IO <br /> BASEMENT: 1ST FLOOR: rI(�r QntrO �Termlt <br /> c <br /> nce <br /> pqq D b ;% T J f 4, TOTAL SQUARE FOOTAGE: � (s opes,d stura , <br /> f inglac ess) , <br /> J <br /> 2ND FLOOR: 3RD FLOOR: d u< <br /> / <br /> RewewLocatl n-Survey <br /> ESTIMATED CONSTRUCTION COST: and available o ions. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 0/ 7 . li <br /> NO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IS eS QNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes fNo ['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? Dyes ❑No <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 fNo ODon't know <br /> 7. Is this to correct a violation? Des ON <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -∎ -► -i <br /> 545-112(4/08) <br />