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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 r„ <br /> I�o1jui 14. ��ITAA1 Sally V. YIcJ S oning Status; CUP; <br /> IDWNERADDRESS (Number,Street,City,State Zip) / Deed Restriction; CSM <br /> y 310 Sun nys id e, ST. 5�vyh�r VU A 535n Variance(# ) <br /> HOME PHONE CELL P ONE E-MAIL DDRESS i <br /> '73 • 3/43 fu zZ�e.J5I & ►1v• us,Mt n Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site PI ncluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w /sep "c <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE n Site PI pproval from <br /> applic I township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 51/oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE p P y <br /> ❑PARCEL <br /> NUMBER 0Lt(P/D(°1)"113 -7k -5 R- 3 d-On) frontage drawn to scale. <br /> /NNSHIP; SECTION: <br /> pi eu.s +fi Si r'I•tgqS '/4: i/4�/4: ❑ Driv way ermits <br /> ADDRESS: J (state, nty, town) <br /> CSM: 3'0 Sun n LOT U e, Sr 3-to uB�l1'1 Ib W I 535$ J ❑ s to permits <br /> (p private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: \ t <br /> � +0 3?oirLJ t O r v p Tor vJk eAci1O i r oning District erm <br /> . ❑This project is a new building or structure. ! itted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rur A•• 'SS <br /> EWER rEPTIC <br /> /HEIGHT IN FE T I NUMBER OF STORIES: (Not including basement) VIIMP <br /> ( ❑ Wetl. -.4406101..-- ain/ <br /> Shore - , (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionCon I permit <br /> BASEMENT: 1ST FLOG <br /> S y TOTAL SQUARE FOOTAGE: y (slopes, • turbance, <br /> 2ND FLOOR: 3RD FLOOR: �+ filling/ S) <br /> I S ❑ Review L tt Survey <br /> ESTIMATED CONSTRUCTION COST: and avail options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ K _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes ❑No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ❑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) DYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Dyes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -♦ -9 <br /> 545-112(4/08) <br />