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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 /> li D)a c,-1-... ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> /067 51✓r Ckcac,) /QcQ. Simi Lc>i 6-05"891 Variance(# ) <br /> HOME PHONE CELL PHONE -MAIL ADDRESS <br /> i "036N ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 'm t'ah hAlr Bt.,, r5 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS& of well/septic <br /> s7&v z/nAto.rt,.eJ Dr. • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 5. Pra.r..E., k// SS <br /> PHONE PHONE ❑ Site Plan approval from <br /> tpg- /y 13773 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 'Q 1.,- . y .. ac'I.GAw• ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> UM <br /> ❑ NBER O5 0570P3Z/I$1(/& 41 /.5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Rvi/Q,a /3 '/<: Nkt! '/1/a: NE ❑ Driveway permits <br /> ADDRESS: � (state,county,town) <br /> /0107 Starr Scharf K(xr 54A.140.. 4" -5--b52?/. <br /> ❑ Sanitary permits <br /> CSM: LOT BLOCK/LOT <br /> 0/065 ' (public,private) <br /> PROPOSED PROJECT INFORMATION 1- <br /> PROJECTDESCRIPTIO• " ' 7 � Z,` <br /> bete _ . <br /> � <br /> gy ,° <br /> m- , ° . <br /> . ®.This project is a new building or structure. ' <br /> ❑This project is an addition/alteration to an existing building or structure. t s <br /> SANITARY SERVICE: PERMIT NUMBER: e a{ <br /> ❑SEWER PA EPTIC i' °,m L, + <br /> HEIGHT IN FEET: ,� NUMBER OF STORIES: (Not including basement) ��, x <br /> -i, -A <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - k ` fir„ ,, <br /> Li, V, ® 1 <br /> BASEMENT: 1ST FLOOR <br /> Zq 4, TOTAL SQUARE FOOTAGE: 4, _ al €a3Y �:74 <br /> 2ND FLOOR: 3RD FLOOR: C 7 , - - E <br /> - r <br /> ESTIMATED CONSTRUCTION COST: ;, i ," a. ?`q , <br /> (Please round to nearest dollar) "'∎ -0. '� -+ $ 13� d0, . A,.,‘-::,.'._- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes RNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes al No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes LNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®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) ❑Yes (3No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes EiNo <br /> I/ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(aroe) <br />