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`;SUPPLEMENT to Wets App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER:INFORMATION .- CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> oafrlet Bra 2.1 e_r ❑Zoning Status;CUP; <br /> 0 ADDRESS (Number,Street,City,StatkZip) N Deed Restriction; CSM <br /> 1900 go i red Lawler Peer i? 1 (/t// 5353/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 05 - <br /> .77Z- 1 8 ❑Site Plan drawn to scale <br /> AGENT`DNFORMATION . .', CONTRACTOR INFORM/mON ,, and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> y <br /> /• �!//e t— — Ro e_ t_1._ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 330/ 1A+4.14 M/07 <br /> (City,State,Zip) (Ci State,Zip) ❑ Setbacks <br /> /),,AN 1,0 537/3 <br /> PHONE PHONE ❑Site Plan approval from <br /> roe) 235- 86117 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION<"(httpl/accessdane co.dane.wi usl). El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0 7/1_23 1/...0 Z/0-0 <br /> NUMBER g H / L. frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 'RA: ❑ Driveway permits <br /> CO ' ��- : (state, county, town) <br /> ADDRESS: - <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> _ , STAFFIRE'VIEW <br /> PROJEC ESCR TION: P4�r L <br /> F- -�Zorimg}Dlsfr.ict �; -, <br /> . 3This project is a new building or structure. © `Permitted Uses t � <br /> This project is an addition/alteration to an existing building or structure. & a M� <br /> SANITARY SERVICE: PERMIT NUMBER: PZR ral Add>ess V <br /> ...,r-°'erg ,�'� s <br /> . DEWER [EPTIC a eW e 1SU 1V� MKc` 4 <br /> Rte-i 4:*:.. _ z -,, 4- <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> . y ' . U Wetlarnd//FloodpIanf <br /> AREA TO NEAREST SQUARE FOOT rt,`.SI0O4adattac4rraeltt) r-. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) art- �`-t �-- <br /> BASEMENT: 1ST FLOOR: EEq ionCo 1f 1pB CT]It <br /> �r/ j TOTAL SQUARE FOOTAGE j ` S�>3)31rS tsIti,pa Ice ,, <br /> 2ND FLOOR: 3RD FLOOR: �� °w �� y t -j t <br /> ®4Revev�i ocattonSuiVe <br /> •ESTIMATED CONSTRUCTION COST: ♦ -I. / �� 1 {�aaab�epfl71s,*zr <br /> (Please round to nearest dollar) Q b xk '. - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EiNo. ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ONo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®Yes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONO <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 JNo ['Don't know <br /> 7. Is this to correct a violation? [Yes MN() <br /> • <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -0- <br /> 54S-112 OMB) • <br />