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SUPPLEMENT to Web App <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION . 0 , CUSTOMER TO PROVIDE <br /> OWNER NAMEf <br /> 6`CSC' �enfi z_ Zoning tatus; CUP; <br /> OWNERADDDORES (Nu ,er, re t,City,Sttate,Zip) / ! r/ g <br /> t�7o Pao 1 /p4 Bal e u //e WI. S3j9 Variance Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE p� E-MAILADQRES / <br /> (d9-23Y-1 99 0 A "e/ATzI,� Chia hi n!' G°Al 1 1 Site Plan drawn to scale <br /> AGENT INFORMATION :. _,'., .._`3 : ,CONTRACTOR INFORMATION, n; and includes dimensions <br /> � <br /> AGENT NAME CONT RACTOR NAM <br /> SO ,a//qck at W 01 W 0irICS 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADD SS • of well/septic <br /> I95.I Saild y r0ck <br /> (city,State,Zip) (City,State,Zip) (A a' ff l ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> O g 235.0735 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION„INFORMATION_ (http a//aecessdane co,dane wi.us/)' __ Elevation of property <br /> NUMBER PARCEL MBE031(x iURRENTzO-. ACREAGE: % f frontage drawn to scale. <br /> TOWNSHIP: ,lj,,_ �) SECTION:��))`\ <br /> 4'1 I tvost 3 '/a: %¼: ❑ Driveway permits <br /> ADDRESS: // (state, county, town) <br /> q.og `'G70l` J�-QQ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION aii STAF `REYIEV <br /> PROJECT DESCRIPTION: + =} , _-S ` -` ' 0; <br /> joning Dlsfract-V '� <br /> . This project is a new buildAg or.structure. _ <br /> 0��ermltted Us��4 <br /> LiThis project is an addition/alteration to an existing building or structure. a � � } . <br /> r- <br /> C�▪Rural Address <br /> SANITARY SERVICE: PERMIT NUMBER: mitt �-,.�..., 4��. �� 4 <br /> EWER EPTIC 7 ▪.(new.e IS I g� c. <br /> HEIGHT IN FEET �,�,�111/� NUMBER OF STORIES: (Not including basement) f � } `N ON .? ' <br /> - .2. /0 ::'4.1_Q ratlarad/Floo4pIarnf <br /> CShofelartd= `.attachmerlt) _ <br /> AREA TO NEAREST SQUARE FOOT w 4• -. . _� µ5' <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -tom h.u.-x-� �- _ <br /> 1=roslo tC-on1ro1 perrnJ <br /> BASEMENT: 1ST FLOOR: z- - 'h t , <br /> 1 TOTAL SQUARE FOOTAGE ,�, ` E s)opeS �jsturba c, <br /> 1iu"� r <br /> acce� ��� -.� <br /> 2ND FLOOR: 3RD FLOOR: or....-.71i1 t ' 4 - <br /> . . / / ❑ 3 eviev Locatt St ley <br /> ESTIMATED CONSTRUCTION COST: 73.c.-3 1`n `-&- arrd�a.at able' c)Pts, e <br /> (Please round to nearest dollar) ♦ '♦ ♦ ♦ --> J(J � _ • :=It � F <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ErNo • QDon't_know <br /> 2. Is there a wetland or floodplain on or near the property? Elves 24o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Dies ENo_ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes VO - - . <br /> 5. Is this roject associated with a rezone/CUP/variance etition/a eal# I/O leave bla none)/ <br /> P J (P PP ) (leave <br /> 6. Is a location survey required? (see reverse) Elves ENo on't know <br /> 7. Is this to correct a violation? QYes 1114 <br /> APPLICATION MUST BE SIGNED <br /> 4.1Aiorio <br /> (Continue on Back) —► -4 _,0.545.1120,0)545.1120,0) • <br /> , . <br />