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ft- G' I <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRO IDE <br /> OWNER NAME <br /> t7ALE I7- ST-OPFEA-5, ❑ Zoning Stat ,CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed R riction;CSM <br /> 6370 ?rrlEAsAN T LA.t4E/ VEllokik Wt 535-93 aria ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS I <br /> 60er-$�5 3253 332-6332- PSTOc FELS ®GI{r.R.TER.t,&Er Site Plan drawn to ale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes d' ensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Si PI including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o I/septic <br /> (City,State,Zip) V\ Ce.,..........__ (City,State,Zip) etbacks <br /> PHONE PHONE ❑ Site PI approval from <br /> ap • able township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ oor ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) Elevation of ro ert <br /> PARENT PARCEL NUMBER: CURRENT ZONING: -, ACREAGE: p P y <br /> ❑ PARCEL 13l—15 6O—S RES3pE ,x A 0..`"(c1"4 (o frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SE 21-496Ni <br /> V E 0-ON IR 1/,. fJ w%: Al E ❑ Driveway rmits <br /> ADDRESS: (state, un II,,town) <br /> 0370 PN EAS r MT L.A V RO N A W r 5 35 9 3 ❑ Sanit. permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 5 5 '-(� tta_ LOsTM N # (pt. ic,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: i 0..,f / Lt <br /> s a IS s - -! <br /> . 2 This project is a new building or structure. <br /> ❑This project'- an addition/alteration to an existing building or structure. aY <br /> SANITARY SERVIC 7: PERMIT NUMBER: °° <br /> I -EWER ❑SEPTIC 4 4 ° <br /> HEIGHT IN FEE : �` NUMBER OF STORIES: (Not including basement) <br /> q 6N �j ,2r4`>:V: <br /> ttr fi <br /> A A TO NEAREST SQUARE FOOT: 7 '^ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) : ;=. p - A <br /> BASEMENT: 1ST FLOOR: <br /> - • =/ 4, TOTAL SQUARE FOOTAGE: + - - <br /> O O ! X t 1 <br /> 2ND FLOOR: 3RD FLOOR: ,, <br /> t■i_o t4 E NO N F 1 (-( o . . Al <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ ♦ ♦ $ $NE p S 5 FREE V24 , m ad d®t_M <br /> (Please round to nearest dollar) �V Cc J,ss z F iE G pt D � . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? des I❑,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ,❑/Yes IV No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? LrJ Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes LiirNo <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) L�J Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes , o <br /> cs-k \,..._______ AP BE SIGNED <br /> (Continue PLICATION on BaMck)UST <br /> 545112(4/08) G ( <br />