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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> o,7 ' e. 4 ,�`e.- / f'a e ❑Zoning Status; CUP; <br /> OWNS ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> 7955 44290/' ,py/ve_, Vvro/JQ / 3 5 ga Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> a <br /> $- a..2.1.76 [Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME /�_ - CO TRACTOR NAME //�� ,J <br /> /ref 1, /Ir /J7a5 e'/I /( S/�a.s6ef 11QGu/dept Site Plan including location <br /> AGENT ADDRESS v /J / CONTRACTOR ADDRESS/� /� of well/septic <br /> 7O dam. J' v-AZ e r-e e 7O a'7, /l'tT/�' 6P6/& Setbacks <br /> (Ci State Zip) \_�� (Ci l(te, iP)/l/�// �t�/�/�"r0� <br /> 1��/� �� Site Plan approval from <br /> PH NE 6O 1 444- 8 applicable township. <br /> �0�3�4�¢¢-6 38 d2 8�J <br /> E-MAIL AD ESS -MAIL ADDRESS ©'Floor plans to scale <br /> /a ■J" & e ld5. �� is anedet f'ass., nef <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Q'Elevation of property <br /> PARCEL 55 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:,5 0'7 frontage drawn to scale. <br /> NUMBER b8O8-31 Z-ZIB°)- a (L-IA <br /> TOWNSHIP: SECTION. , , , Q Driveway permits <br /> �U��x� ./o/ 3 �" NW �`� (state,county,town) <br /> ADDR SS: `/ <br /> 3C zy .SPheI,..tG. gt..c c:, 4 cT Sanitary permits <br /> CSM: LOT Su DIVI ION BLOCK/LOT (public,private) <br /> •% at `- <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Li Zoning District <br /> . gi This project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER KEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) ❑ Wetland/Floodplain/ <br /> =29, 6 Tina Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> C`95 3_ 4, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> C// .1.... filling/access) <br /> 2ND FLOOR 88 3RD FLOOR: 3 '.6 06 <br /> 1:1 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 0.746.0, and available options. <br /> (Please round to nearest dollar) -ii. 4, jczr P <br /> SZ-7.38 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? f Yes Ilo [(Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres EINo 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 EINo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) QYes 'lo ►�'S on't know <br /> 7. Is this to correct a violation? Dyes Cato <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -9. <br /> 545-112(4/08) <br />