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+ SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> ■ <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER lYlQ.N C 1 <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Stree city, tate,Zip) -��� // weed Restriction; CSM <br /> 3�5� 10 e K 5± �-�) 53,-_,32_, Variance(# ) <br /> •ME PH•NE CELL PHONE E-MAIL ADDRESS <br /> a , 11a,0 A Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site I Including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of eptIC <br /> (City,State,Zip) (City,State,Zip) 9Setbacks <br /> PHONE PHONE _ a -gite Plan approval from <br /> plicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) :� Ele tion f property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑ NUMBER �s I ° n3 I ("(,J),0 6 P, — ) - 14 S )- onta drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ,J r ik-Q, 3 1/a: PJ 6, 1414: S ❑ Driv way permits <br /> ADDRESS: (St�nty,town) <br /> 3---) 1 �" Iki e 1" P G ❑ S ita permits <br /> CSM: LOT SUBDIVISION BLOCt�7' <br /> L d 0 -e S O ( private) <br /> PROPOSED PROJECT INFORMATION it All. :STA001.1tEVIE14-4-ifa <br /> PROJECT DESCRIPTION: �j <br /> (� ►c(e ri� (teCK ct`0►1 (,l)t'Si Side CF �jitSe Zoning District ; i' <br /> f <br /> new b Idin or structure. V <br /> CI This project is a ne � ermitted:Use's <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 110o�� PERMIT NUMBER: P'7!"' °uraG' ,,, ` : <br /> ❑SEWER 1a,SEPTIC (fie' exis +'.' <br /> HEIGHT IN FEET: I (6614V/11) NUMBER OF STORIES: (Not including basement) ,k , <br /> c voc,L~k - ,dee,K ��: <br /> ❑ We • +o plaint <br /> S s d (a t chment <br /> AREA TO NEAREST SOURE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLO � Er0Q CQI f3 @rmlt <br /> I"a` 4, TOTAL SQUARE FOOTAGE: (SlC)pe. 4P.4.<'' Cer <br /> fills ',ii—cit..:„. s�h <br /> 2ND FLOOR: 3RD FLOOR: ->-� i ®�� `S-z <br /> 1 °evte ion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ♦ ♦ P /� O and av bl Options x <br /> (Please round to nearest dollar) $ I l� . , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes j 'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes i-No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No 7 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes .iNo <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 0 N Ei Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />