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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 /> Jor,z)n tl 591/0 In 1 `�,�1�'� ; <br /> [✓f Zoning StatusCUP; <br /> OWNER ADDRESS umber,Street,City,State,Zi , r Deed Restriction; CSM <br /> r�lY 1L Wi 31v1 VQ,VT71�rk Vv� 5- "f1_3 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> AO elt PIP I 9 d la i ( tsbcgi ,n? -- ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AUNT NAME CONTRACTOR NAME <br /> 1 C x jg Yl YY) --Cr lb - v1 -iiome ESSite Plan including location <br /> AGENT ADDRESS (�� CONTRACTOR ADDRESS },�,, (�,� of well/septic <br /> 4010 V�j�l gOIm I` i 4Di(� C� 'Eyid Utm 1`C ❑Setbacks <br /> (City,State,Zip) ` (Ciit,State,Zip) <br /> PHONE tD `_) I t 5 11 PHONE Mo `\(i J 9/ Site Plan approval from <br /> (D0b 4�1 t.o'i cbl t QUO L1-3.1 [ ? I <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS. <br /> iS-t 0 .,y oe')QIGp( ft- c,(_ -> [Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: b2�., CURRENT N NG: ACREAGE: <br /> ❑NUMBER �l I2 — 3-8(aELD- O t✓ —1 t 11 frontage drawn to scale. <br /> TOWNSHIP: • SECTInN- <br /> t(v l 61 '/a: Mvj '/a'/a: SA/ El Driveway permits <br /> ADDRESS: (state,county,town)• <br /> 354/- I`e;�,,er-E-Le Id 'Q`(j' , [Sanitary permits <br /> CSM: f J�S'� LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> ,' STAFF REVIEW <br /> PROJECT DESCRIPTION: t <br /> ‘ 6,ek,L\ ^, q f-itr o n I I,l.� \-ko we <br /> . ,i-This project is a new building or structure. ? <br /> C�Permitted .. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: L Rural Address <br /> FIEWER VifEPTIC t3 201Le — ( O37 frievdeoftng) ` <br /> HEIGHT IN FEET: NUMBER OF STORIES• (Not including basement) <br /> �.I /Z I i <br /> AREA TO NEAREST SQUARE FOOT: Shore (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �'E, ior>Lfi ontr�lpermit <br /> BASEMENT: i�O- 1STFL1-iQ- ZI�O� <br /> TOTAL SQUARE FOOTAGE: _�(� �,�5 ►16e, <br /> z_N ,..eeR:6 rage, .3RD FFaLeee- cbrche . P l 9/a ss <br /> C0 1 ?. `--4 2,( CI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 430/ J <br /> 3/b1- sib <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1JYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ao <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 No ['Don't know <br /> 7. Is this to correct a violation? [Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioe) (Continue on Back) ■ -+ -+ <br />