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SUPPLEMENT to Web•App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION - CU•TOMER TO PROVIDE <br /> OWNER NAME <br /> 14-1 Za4 t Q Z ing Status; CUP; <br /> (N u m b e r, ip) / D ed Restriction; CSM <br /> 4477 1 �.E G7 �, 4.<...z_ <br /> - �5�� ariance(# ) <br /> HOME PHONE CELL PHON E-MAIL ADDRESS <br /> 46g'074-0)751 i--o ro�'i t_ b/C-64s 4r4.c� a �'-w S. Plan drawn to scale <br /> 'AGENT INFORMATION CONTRACTOR_INFORMATION nd includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> jya,._ Cam_ 5�, ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS„ r 2 9 f well/septic <br /> (City,State,Zip) (City,State,Zip) ��yy// Setbacks <br /> PHONE PHON ❑ Site 'la pproval from <br /> �� d(c —�7S-'� ap i • ble township. <br /> E-MAILADDRESS E-MAIL DDRESS / <br /> ceoz.� - c ., "oor plans to scale <br /> PROPERTY/LOCATION INFORMATION:':'(http://accessdane.Co.dane.wi..us/)_: - , E vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El NUMBER a,.2 i ''ll, o-v X11-3 90) 3l6 f outage drawn to ale. <br /> TOWNSHIP: SECTIf7 <br /> 7 <br /> Drivew ermits <br /> (st , county,to ) <br /> ADDRESS: <br /> 0)77 1/1i--C'e e ❑Sanita rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 35 (p • , private) <br /> • ; . • , ; . ■ 1 ; / _ • , <br /> ".:;:'!"..:Yr TAF:FREVIEW <br /> PROJECT DESCRIPTION: <br /> R, X6-0 - j g aro v2_ ' oning District <br /> i h <br /> . EThis project is a new building or structure. Permitted e <br /> III This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural dtdreSs <br /> rEWER 154EPTIC new -;„,::.B.,:! <br /> HEIGHT IN FEET 0 r NUMBER OF STORIES: (Not including basement) + <br /> ❑ Wetland/Flo ,i.nl <br /> AREA TO NEAREST SQUARE FOOT: S h0ie1 attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - -- <br /> BASEMENT: 1ST FLOOR: E[DSIOnC011tro '-rmlt <br /> j TOTAL SQUARE FOOTAGE , slopesd1` 'ante, <br /> . /gdo dF g - s' m <br /> 2ND FLOOR: 3RD FLOOR: )Illmg4 i. s- 6' L <br /> ss <br /> APB n ❑1 .*...: eW Locatin Suru - <br /> ESTIMATED CONSTRUCTION COST: ♦ w+ ♦ ♦ ♦ ♦ /��1 an available options <br /> (Please round to nearest dollar) /sew U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes MNo ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? larles EN <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EN . <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) ❑Yes No ['Don't know <br /> 7. Is this to correct a violation? Des KIN <br /> • ,_____f4 ...----- <br /> V T APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -4.► -♦ <br /> 545-112(4/08) i <br />