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;:SUPPLEMENT to Web App;# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY.:OWN ER INFORMATION - < ; t •• -:-;i ' F 6 CUSTOMER TO PROVIDE <br /> OWNER NAME // <br /> ' Tf O..E( 'Bow.) ['Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3030 TDO61v V le-1 ) 1 2l, V 142-0NA, C.vt S- 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-V-3 1 0 1.0 6 3 Sbeas■rre( C S 'C 2,l. eom L to Plan drawn to scale <br /> AGENT'INFORMATIOItI ,. r:_ , . ,.. ;CONTRACTOR INFORMA�TION-S - and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ - e Plan including location <br /> AGENTADDRESS CONTRACTOR ADDRESS • o well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE ! d PHONE ❑Site i-jlan appidval from <br /> • yppycaptd township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> I. [Nkl or plans to scale <br /> `PROPERTY/LOCATION INw ORMATION;'(httpe//aocessdane co.dane Wi us/)_ , Elevation of property <br /> PARENT PARCEL NUMBER- CURRENTZ NING: ACREAGE: <br /> ❑PARCEL 0 w-�c 1,CtA.0 1.t AZ 1 2J') frontage drawn to scale. <br /> NUMBER I'1 <br /> TOWNSHIP: SEC ION: <br /> T fJ OF 1/6�?_,OI�.9A '/4:S '/4'/4: E ❑ Drivewa "ermits <br /> ADDRESS: (state jty, town) <br /> Z7-8 2 u.)W tr QDSS l t>G1--QUr Veyeloc., 1 UJ\ 53S--q 3 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu)afic, private) <br /> PROPOSED PROJECT INFORMATION; - STAFF REVIE*IV <br /> PROJECT DESCRIPTION: t ? A i <br /> I2 ' X' 30' LE.F -T �StIG- FOR- 0°0 a 3 0\120-0Y06, ©zoning Dls[nct�1 <br /> �Y g t,..-�" -{-^ A <br /> This project is a new building or structure. 0 PermittedtUse'n <br /> ❑This project is an additioplalteration to an existing building or tructure. r �'ii `. - <br /> LI Rural Addfess <br /> SANITARY SERVICE: PERMIT NUMB Ri / 3t ,r <br /> EWER - EPTIC <br /> �,I //- t :i6(n evvJexlstlp g) s r <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> - ./0 ' • 1 0 Wetland/Floo4slplain/�R 3 <br /> Shorelan-d attar meftt) <br /> AREA TO NEAREST SQUARE FOOT r - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) :13-it- z <br /> BASEMENT: 1ST FLOOR: ro_sionCo rqi permit <br /> TOTAL SQUARE FOOTAGE • ` SlOpes�`d1stUTba Cg,;vF <br /> Rrrl access oS <br /> 2ND FLOOR: 3RD FLOOR: Y•- I —t, � k r <br /> 3r0��'`- <br /> Li RevieWlo`cation Survey <br /> ESTIMATED CONSTRUCTION COST: d aa e z p if - <br /> ♦ ♦ -0. ' -0. 5- �0 4'(Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives QNo -XDon't know <br /> 2. Is there a wetland or floodplain on or near the property? gfres ENo _QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? A<Aies i 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) [Yes `II • ❑Don't know <br /> 7. Is this to correct a violation? [Yes n o <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />