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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 /> PAWS. A . Sc H Q , ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (9 0 ( Sr kf l3s.) -0 `.70 A) l-\go - -1 1-.7z_ 5'11 19 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS r <br /> `013 -4114-9 • • C 1-4 uT2. C. C'1-•a(tvS. . v. II Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I-1A-.N1 ZC.c‘-'6l_ \°L¢.C2.0i-i .4,« ❑Site Plan including location <br /> AGENT ADDRESS CONTPAr' .-DRESS of well/septic <br /> v-44 1'.osCD E k /tv6_ Sfitr 4•►>3 zr ,tIr i1 24- 14.1 FAR.so rl u-t> <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> ‘`-tCLNeVA-vrc.a. ti�.53202. \Aa t-1W L - 31S1 <br /> PHONE t PHONE ❑Site Plan approval from <br /> 414-Sc2 5-6 n 2 S 3.,z-S9s— 91 L S— applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • q <br /> Floor plans to scale <br /> rh S 1 c , • C C.- . To ■ -11a• _ R ''tLe,A WS ism• <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER 0331. 05c,2eTZ_`3%t0Si (-'3-, <br /> TOWNSHIP: SECTION: <br /> s '/<: '/4/: c , ❑Driveway permits <br /> ∎'c` tA w <br /> (state,county,town) <br /> ADDRESS: <br /> 1(4 'fl S'T Q m.,b n 1-1+,trz=s 0.4 <br /> CSM: LOT 'SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> el—Ai... Er Alm-T,..-r14A G.0 - 1.4th.- �,a ❑ Zoning District <br /> . j2Tfils project is a new building or structure. ❑ Permitted Use? <br /> „Eriiis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) <br /> Q ❑ Wetland/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 /> ❑ ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q� and available options. <br /> (Please round to nearest dollar) �P flit o rc� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eyes Ego ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? lees o <br /> 4. Has there been a zoning permit i : o IGIVED the past 5 years? Elves ❑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 reveBrse ❑Yes E o DDon't know <br /> FEB Is this to correct a violation? 2 7 2015 Des .12No <br /> D )L COUNTY PLANNING 8 CEVE.t;r;L N( -f-ct� APPLICATION MUST BE SIGNED <br /> 4? t ( (Continue on Back) -♦ ■ -► <br /> 545-112(4/08) <br /> z.'? c-,430 . 49. 6.c., `l`, 03c, <br /> 5 3.33 ,4 wA t/tit r+- wv v c:. 6(cl U c'�• j� `{v_ <br />