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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 /> (120%.r L. C c in ...-, ,ri / ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /CP ei7 l-( . fit,)t 1b1 */8 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (po8--C*-R?b t{ (04 is t d jr,,A t rya d. s e/d,c ic_S,(Orr) ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 12]Elevation of property <br /> 'PARENT- PARCEL NUMBER: • CURRENT ACREAGE: <br /> PARCEL / / 9 frontage drawn to scale. <br /> ❑NUMBER D 7/! 3t0 / / �eo A C�� /'E� (2, <br /> g <br /> TOWNSHIP: SECTION: <br /> Coital 6, Grove ,3 G '/.: '7 <br /> . // ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> CSM: T ��/� J SUBD VISION/6 BLOCK/LOT ❑Sanitary permits <br /> 3� (public,private)DO <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3 ,,___..,,,,,.-4. c of/- /4‹ ❑ 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 14EPTIC (new/existing) <br /> HEIGHT IN FEET: rr VV NUMBER OF STORIES: (Not including basement) ❑ n <br /> /0 Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑,E • permit <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 0 Z,c./ <br /> filing/access) <br /> I;;)ydn <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) b© <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes i;4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes rj o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies JNo <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) EYes No ❑Don't know <br /> 7. Is this to correct a violation? 1Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />