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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 /> S7n•,re_ r IrG r S , / 5 X5`6 a oning Status; CUP; <br /> OWNERADDRESS (Number,Street City,State, ip) <br /> Deed Restriction; CSM <br /> X16 /4'+� sg' t � f I►2 f w I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME <br /> CONTRACTOR NAME/� llll <br /> �c„ �Q, .1 dt%ce�� /NC t 1-,-;e7 �������� /Li t e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> g3 J r • 4ktcam. 51-fr i(City,State,Zip) (City,State,Zip) , / tbacks <br /> �✓i1.,� <br /> PHONE PHONE ❑ Site A� � oval from <br /> ?-5 so -6(5'0 appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loon plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: p p y <br /> ❑ PARCEL 1.1-9 J� �f rontage drawn to scale. <br /> NUMBER O����/ / D��v v <br /> TOWNSHIP: SECTION: <br /> / '/o: 1/4'//: ❑ Driveway permits <br /> (state,county, • <br /> ADDRESS: S 1 )- F f' / <br /> on _ r CI Sanitary permits gt/�CSM: LOT SUBDIV ION BLOCK/LOT (public, : ►�F.Sty` • <br /> PROPOSED PROJECT INFORMATION STAFF #,- <br /> PROJECT DESCRIPTION:, f ' <br /> � J',[Ir vL"'ta- 1 "DID <br /> tE , <br /> is project is a new building or structure. F ti ? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: r €MdreSS <br /> nSEWER ITITOTIC T 16 ,,. <br /> I� fig) <br /> HEIGHT IN FEET: /" NUMBER OF STORIES: (Not including basement) <br /> 1 a, ik a4A9� ; <br /> : , a � <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ;# .; �y <br /> I�5 f�I �/a TOTAL SQUARE FOOTAGE: ,, ;# <br /> 2ND FLOOR: 3RD FLOOR: <br /> Ales , c•,w '4 a y <br /> ESTIMATED CONSTRUCTION COST: / d mate s•l. <br /> (Please round to nearest dollar) ♦ '♦ ♦ ♦ ♦ ♦ / t-„,,q,1,_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes [ lo Don't n\\ <br /> p P Y ❑ ❑ <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeso ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [ io <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 [r Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -► -► <br /> 545112(4/08) <br />