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SUPPLEMENT ti ,Web App#. <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY•OWNER INFORMATION . = S_ • 3. „•;;..4•s_ :, '_ W,.: CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> o2►�^- re- < ❑Zoning Status; CUP; <br /> OWNERADdRESS (Number,Street,C 1 a t e,Zip) Deed Restriction;CSM <br /> HOME PHO�EI 3 J i'0 CE P K BIbbr.:0 Ore)`C "/ Variance(# ) <br /> E--4ILADDRESS <br /> 3 S-2' —32L3 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION , -;7,: ,CONTRACTORTINFORMATION , and includes dimensions <br /> AGENT NAME CO TOR NAME <br /> ePn 6 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • of well/septic <br /> ?9S (3- Bu <br /> (City,State,Zip) (C,jjy,State,Zip) ❑Setbacks <br /> `rJ iL : C390/ <br /> PHONE PHONE ❑ Site Plan approval from <br /> t' lif 6.9 7 -//23 - applicable township. <br /> E-MAILADDRESS E-MAILADDRESS - ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION '(httpI/aecessdane:co.done wi.us/)_, ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Ei NUMBER 6-)10.- 32.3-$0- 1 R\-,-( 2.6,2 r frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 2 '/a: '/a'/a: ❑ Driveway permits• <br /> hX'3+I''/ Gn c.' - (state, county, town) <br /> f 3 L 1 a �w,.t' r1� , ❑Sanitary permits <br /> CSM: �� �+ �I SUED I N .BLOCK/LOT <br /> l (public, private) <br /> PROPOSED PROJECT INFORMATION. ' STAFF REVIEW <br /> PROJECT DESCRI?3JON: F *} 2 �I <br /> 1 .©vmm�gDiSfl <br /> • ❑This project is a new building or structure. Permitted UJse7 , <br /> © <br /> his project is an addition/alteration to an existing building or structure. =N -� 71{ 4, <br /> SANITARY SERVICE: PERMIT NUMBER: ©,,R i`ai.Add ess - � <br /> . EWER 'EPTIC ` 0;04.03.0A-� �V' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) oag .� 7 <br /> tWe#la>�007. d�l61 µ <br /> . - Sho?eland='�.attachrr�ept) <br /> AREA TO NEAREST SQUARE FOOT ' `t <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) 't:4`d . <br /> k- ro_sionC�n��jpertyllt-� <br /> BASEMENT 1ST FLOOR: .f - 5..i-,�•� =?.- - - z.� <br /> ZZ� 2.--4- 4, TOTAL SQUARE FOOTAGE: j ,f lA}34 Urbai32 <br /> 2ND FLOOR: ` 3RD FLOOR: ., �R AS.VA z �3 h' <br /> . j YSD Cart evtachtlik afrtn Suet'_ <br /> ESTIMATED CONSTRUCTION COST $ Ill 010.. `• 0 )•rd a a able:00©ns,� r- <br /> (Please round to nearest dollar) ♦ "♦ ♦ ♦ iwL yk _ <br /> ■ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes /Fao • ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes ON ❑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 ENO . <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 ZNo ❑Don't know <br /> 7. Is this to correct a violation? Eves grNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► --I. 9 <br /> 545-112-(4roB) . <br />