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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 /> LEY S.W:NSON ❑ Zoning St ; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> D ed striction; CSM <br /> /aZZ S• PE P- .y� , ,vt1 a ance(# ) <br /> HOME PHONE CELL HONE E-MAIL ADDRESS <br /> 83r-'76-98 • e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Si 9e.6.- C. :r,vr S/VAIA, 8u«_bjNc,.7(Pf«N ime. - Plan including location <br /> AGENT ADDRESS CQNTRACTOR ADDRESS f well/septic <br /> sier Dezi. Pinar 8/Z <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> � 146Hrbtl wi 055el 9 <br /> PHONE PHONE El • e Pla pproval from <br /> ZOOS.-'7/Z -tag z 1,06-i1-77-1/3/ pp le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> 3AcEP 5.t/A u'�g's. F oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CU N ONI G: ACREAGE: <br /> ❑ PARCEL o Z_ <br /> f outage drawn to s ale. <br /> NUMBER 65`6105,O 82-8Sab-• r Q rA <br /> TOWNSHIP: SECT `Il <br /> I TS-RNO '/4: 141%: M Driveway permits I� 1 <br /> ADDRESS: S • g� ijaR <br /> ( te,county,town) <br /> �� BLOCK/LOT Sanitary permits <br /> CSM: LOT SUBDIVISION <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION a TAFF REVIEW <br /> PRO CT DESCRIPTION: J 3 s s <br /> `� Q �. ` 'oning i istnet <br /> . Ed This project is a new building or structure. Permitted OW:. <br /> ❑This project is an additio alteration to an existing building or structure. 7 SANITARY SERVICE: PERMIT NUMBER: �j 'e Address <br /> ❑SEWER SEPTIC �� O �J x)ingy k � <br /> • HEIGHT IN FEET NUMBER OF STO I IES: (Not including basement) <br /> IC) ❑ Watlanc f %adA aitdi Shor d 4attacihment) <br /> AREA TO NEAREST SQUARE FOOT: 10 <br /> • (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ �tOSIO[lOrl +e[mtt y <br /> 4, TOTAL SQUARE FOOTAGE: y (slopes, • 0" 3e, <br /> fiiftng/ ,,eess)0 <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑.Review • atron Survey <br /> ESTIMATED CONSTRUCTION COST 4 ,� afid )iabFe o r.:. <br /> (Please round to nearest dollar) �� © ,. .,.�`. . ti _ ,,,, .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yes CI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blan f none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATIUST(Continue on ON BacMk) BE♦ —0 <br /> 545-112(4/08) <br /> /"/3 7if <br />