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07-20-2009 10:51 CARL RICCIARDI 608 836 3649 PAGES <br /> I S.S4 <br /> SUPPLEMENT to Web•App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,,,, �,p <br /> ADD 1 s nvb�L.�. 'I o L_. . .— ._ Zoning Status;CUP; <br /> / OWNE DDRESS(Nlifiber•SVeet. State.Zip) Deed Restriction:CSM <br /> ` / - - - __ <br /> \\\/// �.I ?. Variance(# ) <br /> •NE , • CELL 'HONE E•MNLAOORESS <br /> ,li..:,;)-- 1.4 i,'— 1, -16S - '1. Ito Plan drawn 10 scale • <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ■i a m i; S 0, Lo Ec UE ro it ►i Le k '(.., ite Plan including location <br /> AGENT AnORI:•SS CONTRACTOR ADDRESS •f well/septic <br /> 7 5- C),s /� y t a_ S7v as. i w� /2 . <br /> • <br /> 4c.,,,c,,boo tele,zy,l ( �.zip) a•\ Setbacks <br /> W t c„, ix 5391 . . <br /> Site P approval from <br /> PN (4 O S) 3 c(.t '3(� ( a r ll b`35 -36/i ap j ' township: <br /> E.M O ADDRESS E-bWLAODRESS <br /> ►� Floor to scale <br /> PROPERTY'LOCATION INFORMATION (http:;:accessdarte.CO.dane.wi.us') <br /> PARENT _ fAJRRENT7.ONING: ACREAGE: Elevation of property <br /> O PARCC R I;/! y / • 42--'1.- _ ,tage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .'�-�— - %: S E 'h'/.: m t- Driveway�:miffs <br /> — C '' (state •.unty,town) <br /> '.c / L. .. ' '--r ')tdi-5./,y7 1 • musty permits <br /> cSM: LOT SUBDMSION SLOCKLOT <br /> (public,priv-te) <br /> r <br /> PROPOSED PROJECT INFORMATION) •` �'?`-"-*"-"ir- ' r"..--,:„T'Y <br /> . PROJECT DESCRIPTION: S �!(� `.' D C <br /> This project Is a new building or structure. _ <br /> ❑This project is an addition/alteration o an existing building or.structure. _ <br /> SANITARY SE : PERMIT NUMBER:r <br /> SEWER ❑SEPTIC <br /> ri,CE <br /> HEIGHT IN NUMBER OF STORIF„S: (Nm Mcb.dbg DesemeM) <br /> AREA TO NEAREST SQUARE FOOT: . - <br /> (Outside dimensions ind • - attached garages and above grade decks or porches) <br /> BASE 'ST <br /> j TOTAL SQUARE FOOTAGE 4, - -. _. .' <br /> 2ND FLOOR • �^(TI <br /> •ESTIMATED CONSTRUCTION COST: f <br /> (Please round to nearest dollar) -► ► -► -♦ -► -► $ iff,ir/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ViNo la Don't know <br /> 2. Is there a wetland or floodplain on or near the property? °Yes Ito ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement?_._ Yes ❑No <br /> 4. Has there been a zoning permit Issued for this property in the past 5 years? Jar 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) 0 Yes $No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes IttNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112( (Continue en Back) -► -e. -, <br />