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4'7 6_ ci-0 -;SUPPLEMENT to,Web•Am <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION , , ; s = ''= f: CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> e" T c <br /> Q N\ JcIN\C Wing Status; CUP, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5 `� �iNc�\►.1Cso>J w Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (oce6 2o9D73 �,S4teian drawn to scale <br /> 'AGENTtINFORMATIOItI , ,CQNTRACTOR:INFORMATIQN l- and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .. .--+=)-(-`"T i Z,4.-ti g� AA ��� S. e Plan including location <br /> AGENT ADDRESS GQ CONTRACTOR ADDRESS Z of well/septic <br /> W ��l tN S 1 131 C_.:t`1 L1.AN t. 'bL <br /> ity,State,Zip) (City,State,Zip) etbacks <br /> 'T�J c_.,1 53�3� c,` ... • wt m Lf <br /> PHONE PHONE ❑Site PI n proval from <br /> applic township. <br /> Cs,� c9c cc 7C 37 be LA4K 2c 3� <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> pal a a L loor plans to scale <br /> PROPERTY/LOCATION INFORMATIOM_ -(httpNlaceessdane co4ane*.us/) ! _: Eleva o property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL BER t�— -s . /-7 1 C n D f1)1 — 13 fron drawn to scale. <br /> NUM <br /> TOWNSHIP: SECTION: <br /> U Lcos( <br /> '/: J V //: ❑ Drive ermits <br /> (st , unty, town) <br /> ADDRE <br /> —.S -3 t— 1 " /i71. <br /> 1'1 /1? )I ❑Sanl rmits <br /> CSM: LOT U SUBDIVISION______________BLOCK/LOT <br /> os 9 , (publi , rivate) <br /> PROPOSED PROJECT INFORMATION s ;STAF .RE'I�I�EW <br /> PROJE DESCRIPTION: z� a 5 <br /> ( (\. I? ,M ) l Pe 7L AC' oning Str,10 <br /> . This project is a new building or structure. '. {ermttted-User r - <br /> This project is an addition/alteration to an existing building or structure. t r 3 _ <br /> SANITARY SERVICE: PERMIT NUMBER: C#,Ru1t Address M * 4 _ <br /> DEINER [EPTIC i h rteWl a ma. <br /> r <br /> HEIGHT It FEET: NUMBER OF STORIES: (Not including basement) `' 'a 7 <br /> . I�(9 M D •e/Flo. plain/T 3 * - <br /> Shot ,tnep <br /> AREA TO NEAREST SQUARE FOOT: '° , ,ti <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) a� , _ <br /> BASEMENT: 1ST FLOOB� { te anr� eCTtlt' :Y <br /> S 1� ;l TOTAL SQUARE FOOTAGE: ,,, `, 31gpes 1J.� .� 1.1C.E�_...i <br /> 2ND FLOOR: 3RD FLOOR: Y q - xt.. . -,v 1 3 3 <br /> w �., <br /> :. _...,,,f�evieY=Lobatton 1-170Y40: <br /> ESTIMATED CONSTRUCTION COST: �`F z ';� � t 4. 1 �-��xCd a�a�abiez�ptl E«� <br /> (Please round to nearest dollar) ♦ ♦ ♦ P I (J _W 3 F - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ❑No ' ❑Don't_kn; <br /> 2. Is there a wetland or floodplain on or near the property? [Yes fNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes • 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? Lives ❑No . <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+ <br /> 545-112{4/08) <br />