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No,i) <br /> N e <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT LIGATION www.countyofdane.com <br /> . . <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I� <br /> �41an L. Seb,�nek. a , k ; 1)..shearte..49 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 281f 1444400-n a StAkt !Ulf t &)r .S1 7O Variance(# ) <br /> HOME PHONE CELL PHONE IQ E-MAIL ADDRESS <br /> (QO -g3 7-2444 66e-5(4.7)77o a(a.r,Set+ranek@bxnkeFcht, 0•77t?iCtakt ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I, ' eti.)iiet' ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR DDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> Ct{_57 --ex 7Yc applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .1u4 t,S,76,co cc t�"tks tk,, i 0416;6;41 ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL A - .',00 frontage drawn to scale. <br /> NUMBER 1 <br /> TOWNSHIP: SECTION: <br /> ZrTSItbt IA: '/<'/a: ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 7,1) •Vr‘/Ibdtrl Al. I Sm. , Pietrn , (Aix 5'S90 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCKILOT <br /> ell i S i (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ' ` <br /> New Sited ❑ Zoning District <br /> • ®`This project is a new building or structure. _ ❑ Permitted Use? " - <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER: ❑ Rural Address <br /> EWER (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) . <br /> /¢s/"e '" one. ❑ Wetland/Floodplain/ <br /> -..A i NEAREST SQUARE FOOT: Shareland ,(attachment) <br /> (Outside dimensio c.' unfinished area, attached garages and above grade decks or porches) rr <br /> BASEMENT: 1ST FLOOR: — ❑ EroSlOnCoMrOI permit <br /> — 4i-2')c +0 + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> (,IQ1i� <br /> �_ .. 0 Review location Survey <br /> ESTIMATED CONSTRUCTION COST: v1C: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ "� '� . 0 c)CL/, -~--- - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes FINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des nNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [K]Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EN <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? ❑Yes [21No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/06) 'r_ (Continue on Back) ♦ -+ -►) '7 () ' <br />