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:SUPPLEMENT to Web App-71 <br /> ZONING PERMIT APPLICATION www.countyofdane.com • <br /> PROPERTY OWNER INFORMATION - CU OMER TO PROVIDE <br /> OWNER NAME <br /> j/ I// friAA f<a■sl Ic / Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,jip) Deed Restriction; CSM <br /> 300' V l/440.2f.. CA el riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> Iii-3 YJ=- 9io • to Plan drawn to scale <br /> AGENT?INFORMATIOhI , ,; '.CONTRACTOR;INFORMATION_ = nd includes dimensions <br /> AGENT NAW CONTRACTOR NAME <br /> AI0 • e Plan including location <br /> NTADDRESS CONTRACTOR ADDRESS • f well/septic <br /> (City,State,Zip) (City,State,Zip) Setback s <br /> /17 i/On l.)•S Sa3C36 <br /> PHONE PHONE ❑ Site n approval fr <br /> 6 ad -a? —43.02y plicable t ip. <br /> E-MAIL DRESS/! E-MAIL ADDRESS <br /> ❑ Flo plans to s <br /> PROPERTY/LOCATION INFORMATION (http;/laccessdane:co,dane wi us/) _ <br /> PARENT PAR EL NUMBER:/. CURRENTZONING: ACREAGE: ❑ 1=leva n Of property <br /> Ei NUMBER 0,11 .. /? -I/00)S ,O ,R - 1 • ? fro ge dra o scale. <br /> TOWNSHIP: (' r(CS $0 t SEC I <br /> IBJ` '/a: L` '/4'/a: ❑ Dnv ay permits <br /> ADDRESS: / `� y� �/� ate, c0un own) <br /> 3 © © t r W 0 o� ❑Sanitar, permits <br /> CSM: LOT SUBDIVISION B OCK/LOT i I r c, private) <br /> PROPOSED PROJECT INFORMATION: .- 'STAFrREVIEW <br /> PROJECT DESCRIPTION: (' q ;, -: <br /> p� �O Ie-C- '0- Zoning Dlsfr W <br /> . ❑This project is a new building or structure. '-� Permitted se'k :" <br /> + This project is an addition teration to an existing building or stru tur fi 0. i <br /> 3 <br /> 0 Ri ar., •die55-.�� ; a <br /> SANITARY SERVICE: PERMIT NUMBER: i. �, r� ,��� � 3 <br /> DEWER - . EPTIC =n neW�` gel <br /> h <br /> HEIGHT IN FEET co ( NUMBER OF STORIES: (Not including basement) '* � -r '- <br /> .LI Wetlatid/Er ,OJPI - <br /> Sharer attaphmept) <br /> AREA TO NEAREST SQUARE FOOT Y� r, -S-�4 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �,,E[074F1�-O,rl1e It' <br /> BASEMENT: 1 ST FLOOR: J =- " iI � <br /> T Al 1 TOTAL SQUARE FOOTAGE , `'vslope�s d]S Bat1C4 s _ <br /> .. Isttgoeilnagotetta <br /> 2ND FLOOR: 3RD FLOOR: I/4 f� t x r> / <br /> RevieviilacatlonSOOey <br /> ESTIMATED CONSTRUCTION COST: -and atabjezipttat <br /> (Please round to nearest dollar) --► --► --► ♦ --► -t. � l®� 3 0 v 04 _ <br /> J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des No - ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes (NNo, ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Wes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes NO , <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if •ne) <br /> 6. Is a location survey required? (see reverse) Elves PI o o ❑Don't know <br /> 7. Is this to correct a violation? Des C/No <br /> APPLICATION MUST BE SIGNED- <br /> 545-112{4l0e) <br /> a' 3 0 1 (Continue on Bac() -► -4 * <br />