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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O ER NAME '� . / g� <br /> )a�u\r�C . 8es 'Scor∎S C. `.x,.k.s /�1 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �� 1`'.`^�� geed Restriction; CSM <br /> OM PHONE ���� C(M S\OU �1""E-MAIL o RESS �� � Variance(# ) <br /> 1 , -)-(Ak- i4 • • I ,OS--')1 • % i vy,c,‘ ' . • "T i vC�1\a." t. • - ,.1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions W <br /> AGENT NAME CONTRACTOR NAME <br /> OSi • '• luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • well/septic (� <br /> j (City,State,Zip) , (City,State,Zip) - J'Setbacks 2 4 2/7 s / o <br /> PHONE PHONE IN Site Plan approval from / _ <br /> applicable township. l <br /> E-MAIL ADDRESS E-MAIL ADDRESS X <br /> A Floor plans to scale /! <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �� Elevation of property ,/�! 7g• <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p rtY / (F <br /> PARCEL i` fronts a drawn to scale. <br /> ❑NUMBER b��O 13�-�aOO-O •w.\ ' �& iI ■ores <br /> T SHIP: SECTION: / rT(.[ <br /> NK.A-v nl�l '/a: '/a'/a: ❑ Driveway permits _f f J <br /> ADDRESS: �j (state,county,town) <br /> 3 2 0 / 'Sanitary ••— ••• <br /> •mss <br /> CSM: LOT SUBDIVISION BLOCK/LOT (publics ]1\��l(a) <br /> S '. ._ Yti r <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: Zoning District /f—/ �` <br /> sk(vc o n (,C Yl k� Hry--k.., L/�i� <br /> . .®This project is a new building or structure. Permitted Use? Y/7/ `) <br /> ['This project is an addition/alteration to an existing building or structure. S! k- /75 ( <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rur,= Address <br /> EWER P4EPTIC ,' --30W0--Cooq` Li xisting) <br /> HEIGHT IN FEE NUMBER OF STORIES: (Not including basement) ^,' <br /> M = iW.S \ V I Ioodach <br /> g horeland ,:ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) / ErosionControl permit �© 300 <br /> BASEMENT: 1ST FLOOR: <br /> 3 '1 3� ,, TOTAL SQUARE FOOTAGE: 4, <br /> (slopes,disturbance, <br /> d I filling/access) 4to 2N FLOOR: 3RD FLOOR: <br /> — 5 J /Review Location Survey 1 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ : s and available options. //- <br /> (Please round to nearest dollar) cco <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes _2No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a <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) Dies a. ['Don't know <br /> 7. Is this to correct a violation? :Yes ao <br /> APPLICATION MUST BE SIGNED <br /> 1 (Continue on Back) <br /> 545-112(4/08) 6 <br />