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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 /> IcAR.6NNDP eA4-Se v) Z ping Status; CUP; <br /> OWNER ADDRESS ( umber,Street,City,State,Zip) eed Restriction; CSM <br /> /o64 Q- ' w iy 6 C avut/L,c.C w a 5-3513 ariance(# ) <br /> HOME PHONE I CELL PHONE E-MAtL ADDRESS <br /> 603 22. - 24 9A.-i_ r+ @ sizADe rwe ZA+'-'• AA. S' e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CZkAa.`i g-) ,L 0 5-'e, cA4v. ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /10 AVGL I 51- ✓Gi..e.,r,A•1 1...I <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE//-r ❑S. a Plana val from <br /> IIP'Ogl '375-o/7 2 ppli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Tomes e-K-@ Cc Go i, o ,...., loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) e Elevation of 5-0 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p <br /> ❑PARCEL frontage draw scale. <br /> NUMBER b14/061a. --Z.OA-9W60-0 F- F1- 1 <br /> TOWNSHIP: SECTION: <br /> �0 '/a: Sc �,1/,: s e ❑Drivew permit <br /> C�(L+srie'N>} (s ,count own) <br /> ADDRESS: <br /> /o 4 CTw 14"I'LOT ❑Sani . permits <br /> CS LOT SUBDIVISION BLOCK/LOT <br /> 007A (1°• ic,private) <br /> PROPOSED PROJECT INFORMATION 'STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6AKAI,6 2 b 9c NI 'oning District <br /> . EIThis project is a new building or structure. LI Permitte e? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rura Addres <br /> (new/ 'stin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 15'i „ 1 ❑ Wetland/ odplain/ <br /> AREA TO NEAREST SQUARE FOOT: Imo Shor nd (attachm <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: r-, ErosionContr ermit <br /> j TOTAL SQUARE FOOTAGE: +. (slopes,di rbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/a SS) N <br /> 3 2g CI iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► and available options. 0 <br /> (Please round to nearest dollar) 3a 065 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes O[ to ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes r o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 7 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 none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 1lo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Do <br /> 0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) C <br /> 1 (Continue on Back) -+ -+ -0 <br />