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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 /> 09c.r k C 5c, k rn ,r; } ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restriction; CSM <br /> /(v ti 1-( - 1~Ir.Jv 1P-. 41$ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I(poe-Si( -`111,V (14;!s ( sledd'Arad s efd,tFS,c ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: 'CURRENT ZONING:,: ACREAGE: <br /> ❑PARCEL D 7//3G t 900 A C"O . /._a frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Ct)}Ia a e Croy . .?Co +/.: "7 +/4+/4: // ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> )6 / cs . i-/- A l : ,-6, <br /> CSM: LOT J SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 3'100 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEWS <br /> PROJECT DESCRIPTION: '-� -f; e <br /> 3 —col ve .5 mar /-71‹ 0 ZoningD tnct <br /> This project is a new building or structure. ® l i r <br /> l?ermltte� see <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Ruraik..ress� <br /> EWER IX 6EPTIC tin g aeXl ) <br /> HEIGHT IN FEET. ` NUMBER OF STORIES: (Not induding basement) - �_ ts l <br /> /01 D Wetlan 7l jn/ <br /> Shoreland (a tac ment) "' <br /> AREA TO NEAREST SQUARE FOOT: . ti .lI - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � x ` o.;v° <br /> BASEMENT: 1 ST FLOOR: ❑$ErOSIOn ontrOI permit <br /> TOTAL SQUARE FOOTAGE: , (slopes,d sturbance <br /> mss-� �,„ <br /> filling/access <br /> 2ND FLOOR: 3RD FLOOR: 2 LI D ▪ r .— <br /> ❑Revi411ocafion 5urve ,mot,, <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ ♦ ♦ �o • a d avallab e ..tlOns'�'' <br /> (Please round to nearest dollar) i�t'jQ i <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes j 7,�No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes (j o ['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 No <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 No ['Don't know <br /> 7. Is this to correct a violation? EYes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />