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71 <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> gO6EA e 6E VY .iJORE S Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction; CSM <br /> 17& DUNIl WOOD WAY Variance(# ____) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> $T3 —403a I e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> MM6 OCONNELL — 54112w £J►LbIN6 .4- DESi6N SAC. Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3185 06E4 Po►N-r ORiv6 <br /> (City,State,Zip) (City.State.Zip) Setbacks <br /> OREGON LW 53S7S <br /> PHONE PHONE Et"g:-Ite Plan approval from <br /> ,O8-871_i13 i applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 13E-rh Q. 5{wobv►taea. Ct loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn nation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE: <br /> 0 PARCEL <br /> NUMBER 02%/x610-33i -60%9-0 R-% .$03 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> •'rbwN OF DUMJ _13___ 1/:_SE 1 1 y,;_/VE Ivewaypermits <br /> ADDRESS: {state,county,town) <br /> 115a OUNNW000 WAS( anitary permits <br /> CSM: LOT SU DIVISION BLOCK/LOT + i <br /> vp�r,NC, T2EE (public, private) 11 <br /> i NSooO ,i S <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,.,/ <br /> 12 X.2.(' P,OO rfloA) l7 Zoning District <br /> . ❑This project is a new building or structure. (�1, tmitted Use? <br /> his project is an addition/alteration to an existing building or structure. �' <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad. s <br /> EWER 1EPTIC (new/' , <br /> HEIGHT IN FEET: ► NUMBER OF STORIES: (Not including basement) <br /> 13-0 � tland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> osionControl permit <br /> �� 02 5 a Sa f f j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0' iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ nd'available options. <br /> (Please round to nearest dollar) 521000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LJYes slo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes 'No UDon'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? QYes ®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) DYes alo DDon't know <br /> 7. Is this to correct a violation? DYes ao <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► -* <br />