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? SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ph, R aka r 5 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (joys L, Iwc- LA,,.` , C•o 5 s P/a,As, r 5 3 S' - Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (s08-t 20 '.3 2 9(+, ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME _ CONTRACTOR NAME <br /> Darr « E <br /> .' 5ti <br /> a� (R A) S-tbAC Mt C.OAS7r.+c1tc . ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3 510 Qsfwvti Vice. St N3o1'1 /L/r" ,4ue. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> /v‘,aalt r,/ L)r S 356Z- Monrot• LOT S3Stce <br /> PHONE PHONE ❑Site Plan approval from <br /> (908-S S I -55 ZZ es. Z\ (008- 325 - &oO applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c)o.v r ,n @- 'reek e'■-4 . cow. 501}c,,.A aC'1-.1)S•AC\--- ❑ 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 0807- wy_ 9(A/0 -o A— j (E9 Ti.p frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 3trr (J� 1 D +/,: 5 E. IRA: 5E_ El Driveway permits <br /> ADDRESS. (state,county,town) <br /> Sri30 5�IA,,, Roc,6, Cross Pict,As <br /> CSM: LOT SUBDIVISION BLOCK/LOT El(public, permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> r r<c 7'11 13 a m A e a fi,c A ❑ Zoning District <br /> . EThis 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: 0 Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: OF STORIES: (Not including basement) <br /> 3," NUMBER I L Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ ErosionControl permit <br /> z y $8o 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> ' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --1. ♦ $ S cO and available options. <br /> (Please round to nearest dollar) , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Nlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres �No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes jlo <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) Efres Erlo ❑Don't know <br /> 7. Is this to correct a violation? Efres ENO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ -+ <br /> 545-112(4/08) <br />