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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 /> c ge4 4-.m 1.1 44wrikei ❑ Zoning St ; CUP; <br /> OWNER ADDRESS (Number,Street,City,Stat ,Zip) Deed striction; CSM <br /> OS y37L 67v4E H S rasp 1 l�l s 3 ,5�� Va • nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3,8- 1 1 419 I 'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A ENT NAME CONTRACTOR NAME .,/ <br /> ivv41 IMArl'ev) i—e-1 �Build des u. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> --'Am ,2416/ cov'✓T Dp ve <br /> (City,State,Zip) ity,Stat Zip) It/Setbacks <br /> ----Am, w+ f ra(ril , (t4/I 53690 <br /> PHONE PHONE <br /> q.Site Plan approval from <br /> Z / Z_ 6,4i 34- (ceii 3 7—I Gf 3_ applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> --I•A r YUlid IM n-tell w l t d bl u e•set EKloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT❑ PARCEL P© E�N}1MB�R�' — �� CQURREONINI: ACREAGE: <br /> g <br /> II frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTIQ(/'� , N F. 1/41 ' ( 1 �riveway permits <br /> 1 I'll �4: l/�J <br /> ADDRESS: Q o �/�� 1^ l�, <br /> (state,county,town) <br /> a 14> n • " 0 O permits <br /> ❑ Sanitary p <br /> CSM: LOT SUBDIVISION BLOCK/LOT blic, private) <br /> • PROPOSED PROJECT INFORMATION .'S • FF REVIEW <br /> PROJE T DESCRIPTI N: <br /> 4rcw 1 91 -CAM ply ILME N- I d �C., 5 Zo,Ing District& <br /> . CI This project is a new building or structure. '.ermitte i Use? ._ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: / PERMIT NUMBER:r , ® ra AC)drBSS'�e <br /> WER rw�/SEPTIC ti 1\ o new xistf('is > iti* <br /> HEIGHT FEET NUMBER OFS TORIES: (Not including basement) t e la toodplaini <br /> Silo and (attachment) x <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Q ErosiOnwon • permtt z <br /> BASEMENT: 1ST LOO: ' i <br /> 905 G' Q� 4, TOTAL SQUARE FOOTAGE: ' ( pes, • i'b "nc�r , <br /> 2ND FLOOR: 3RD FLOOR: <br /> hill' Fss 40 : <br /> g3 <br /> R Reviewtocation.Suiv <br /> ESTIMATED CONSTRUCTION COST: d and avai[ab(e options x <br /> (Please round to nearest dollar) $ - / Qoa ,;,� ,„,.. . .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Li Y9s L No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? l YYes ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes iLE No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blank if none) <br /> 6. Is a location survey required? (see reverse) IdYes ❑ ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes allo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />