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SUPPLEMENT to Web-App U <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME • <br /> V e (2-- ctiLd n .001, r Li___(_. ("Zoning Status;CUP; <br /> OWNER DD SS (Number,-.eet,CI te, Deed Restriction;CSM <br /> 6 1 1,0 0.f A / t I 4 / (a.!c. 1 I Variance(# i <br /> H M O CELL PHONE EMAIL ADDRESS <br /> 6t...."014.31 CELL • 13 Site Plan drawn to scale • <br /> AGENT iNFORMATION I CONTRACTOR INFORMATION "and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> AGEN�^ ,�E • ki6by e LISite Plan including location <br /> T ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,state,Zip) (City,State.ZIP) L.3 Setbacks . <br /> PHONE • PHONE • • ❑ Site Plan approval from <br /> applicatlle township. <br /> ' <br /> E-MAIL ADDRESS E•MAILADDRESS <br /> GI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:laccessdane.co.dane.wi.usl) 0 Elevation of property <br /> PARENT PARCEL NUMBER: L%) CURRENT�ONING: ACREAGE: ^� 'frontage drawn-to scale. <br /> NUMBER �T(RJ 6)�3 - ••-r>? C) A � ( , / / <br /> TOWNSHIP: l ' { SECT1Oti''l 14:,___. �' ❑.Driveway permits <br /> add\� 4�1 �� `{ '/+'/`: (Sate,county,town) <br /> ADDRESS: ..,' t.:,..) ,il j r ' <br /> ,� <br /> 6 I F \/ j 17 C L 1 I7 ,@'Sanitary permits • <br /> CSM: LOT q r SUBDIVISION BLOCK/LOT (public,private) <br /> 9 You- -(olio <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: . <br /> r VA Co�Cj�r�� i�� • <br /> . ®'This project is a new building or structure. / ),&( <br /> 0 This project is an addition/alteration to an existing building <br /> or structure. re CcL. <br /> SANITARY SERVICE: — PEBMI NUMBER.""�,��ff (� l- <br /> ❑SEWER `0 SEPTIC , C!4)` a " 00 ` 0 <br /> HEIGHT IN FEET. 36 J 3,9 NUMBER OF STORIES' (Not Including basement) <br /> I _ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gara•-s d above grade decks or porches) . <br /> C� d se>n - 1ST FLO� � ,„, fii <br /> TOTAL SQUARE FOOTAGE: 4, • <br /> D F10'' \'«� - •FLOOR: �r� j P lJ 9,..... <br /> lq(c_ , I <br /> ESTIMATED CONSTR e '= . —1. -1 --1 —► $ 4� 3 f1 0 <br /> (Please round to nearest dollar) w ,,��,/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes tNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes (.No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? *Bs ❑No <br /> 4. Has there been a zoning permit issued for this property In the past 5 years? s ONo <br /> 5. Is this project associated•with a rezone/CUP/variance(petition/appeal# ) (le,ve blank if none) <br /> 6. Is a location survey required? (see reverse) Yes 0/No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lb No <br /> APPLICATION MUST BE SIGNED <br /> •;. ) 9' 7 (Continue on Back) —± —.. —► <br /> , tom; <br /> 545.112(aroe} � 9 <br />