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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> oVANER NAME c' <br /> Q)JD J(°0WA ❑Zoning Status; CUP; <br /> OWNER ADDRESS,(Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1311 SC 6I C) a k an S35(1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> e3 I. G 7(•7 ❑Site Plan drawn to scale <br /> AGENT INFORMATION ; CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ikc.LtPB&Jav Curer &if f-pi,vC.ng iJ/ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> is &fY ',AD <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE /4 S3S�3 0 Site Plan approval from <br /> Cog) Zzs-- ) ?Li 9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ed3DRESS 1 <br /> brad CI+/W Q'f'tj14 her ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER:peO S. - CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL ('�LM 3�����.{ � `� (,t0_ Z ,,� frontage drawn to scale. <br /> NUMBER Y A- y <br /> TOWNSHIP: SECTION: <br /> S P'C1 NW(4.0:0 . . '/4: 1/4'/4: ❑Driveway permits <br /> ADDRESS: //�� (state,county,town) <br /> 131 1 S CIA t���nb1 64.0 ❑Sanitary permits <br /> CSM: LOT sue9lvlsI1onN BLOCK/LOT (public,private) <br /> ` <br /> PROPOSED PROJECT INFORMATION 1 STAFF REVIEW <br /> PROJECT DESCRIPTION:f <br /> U, >c 1t . ❑ Zoning District <br /> . ['This project is a new building or structure. ❑ Permitted Use? <br /> QThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER .IREPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/F000dplain/ <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 /> Ofio Lie,t W" (_(,p( '• 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> T�1p mss$ <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ( (. O <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ► ♦ ♦ ♦ -► b0 �� and available options. <br /> ..+(Please round to nearest dollar) $ ' al 6 <br /> * IZ°I-Sa <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ]Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C Jo <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 1PVo ❑Don't know <br /> 7. Is this to correct a violation? Efres EVo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ <br />