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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 /> B CA t'% j-I e I I L Zoning Status: CUP: <br /> OWNER ADDRESS (Number.St a a. <br /> State.Zip; Deed Restriction: CSh1 <br /> 2./b • o w 01 S� o.(' S ttq l ll� S35$ 9 Variance(# ) <br /> HOME PHONE CELL PHONE 1E-MAIL ADDRESS � <br /> (o0 8-c,bq-CMI 17 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AG4NT NAME !CONTRACTOR NAME <br /> LOEl r 0. p10r5c jy5 I ' arS-C(/‘CLIA rp i I3c., Id-QiS 7 Site Plan including location <br /> AGENT ADDRESS1CCONTRACTOR ADDRESS Qf well/septic <br /> 135'1 L'i(Ay J Rte' i 35`I 8c44-,-e 7 <br /> l cty.State.zip; i(City.State,zip} 1 • I i Setbacks <br /> 1 teP<-cicId Wi S353 ! Z Q..fr,Ci 2lol W i 53 S3 <br /> PHONE I PHONE • YSite Plan approval from <br /> (0b 8 -`101 - So 1 s I Cp 6 6 '-- (0Cl 9 -77 2-3 applicable township. <br /> E-MAIL ADDRESS 'E-MAIL ADDRESS <br /> n"o (-5 c1^ O h p 4 ,y,,„,, I ' Cori Wi! Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.usI) �,/ <br /> PARENT I PARCEL NUMBER- !CURRENT ZONING: ACREAGE i, j Elevation of property <br /> PARCEL OQi Z`Z i�l'gyy/�'..0 ! N_'Z - . 10 frontage drawn to scale. <br /> I NUMBER l l V <br /> TOW NSHI P I SECTION. G 1i[J(/ <br /> Yo rk Z '/: NE '41/4: SL I—�/ permits <br /> I <br /> 4. - (scat ,county.town) <br /> ADDRESS: C l I <br /> LP tO I J (- • A- r.1A7 T rY10,r ?rtt W 1 Sanitary permits <br /> GSM: !LOT !SUBDIVISION ;BLOCK%LOT <br /> ' 3 g y I (public. private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �/ / / J / <br /> R Q Ili o Pe t Yi s l r ,ic, ti 0 m -P _`+`'o b ci , Id ✓�1E'w L��1Zoning District <br /> - !Z'iThis project is a new building or structure. d'Permitted Use? <br /> ! <br /> This project is an addition/alteration to an existing building or structure. �// <br /> SANITARY SERVICE: !PERMIT NUMBER - - l.� Rural :.-.s <br /> HEWER t*EPTIC 13" Z.OI(e — 6 0 j s/ (new -xisting <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not inciud.nC oasement'': <br /> r iS 1 ❑ Wetland/Flola <br /> Shoreland ( t c ent) <br /> I AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> •BASEMENT 1ST FLOOR' ErosionControl permit <br /> ZO ) (P 2 j 4. TOTAL SQUARE FOOTAGE: 4, (slopes.disturbance, <br /> . ` — _ filling/access) <br /> 2ND FLOOR: 3RD FLOOR <br /> Y2. 5 '7 <br /> Review Is , ti Survey <br /> ESTIMATED CONSTRUCTION COST: -� -i -� 350 vow n and availa le p ons. <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? j (Yes INo j_iDon't know <br /> 2. Is there a wetland or floodplain on or near the property? 1 (Yes l)dNo I 'Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ( !Yes I Y INo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? II Yes !jNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 1 (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ' Yes (-- INo 1 Pont know <br /> 7. Is this to correct a violation? !_Yes I y INC <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —# -+ —o. <br />