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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE <br /> OWNER NAME <br /> 111641-- fir-le7.5-7,74. Akinaz.6 zw. • Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3jg2. OuHCmt' .047?-79 Variance(#___ __ ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> &O X73- 12;77 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> tiNiMo /gyp WDr,07- pawpaw, I IBC. ❑ Site Plan ' uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f septic <br /> 5'24, COMI HI4'(, A-4 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> _5kN pep,-(04 CI LI 53590 <br /> PHONE PHONE ❑ Site Plan royal from <br /> _g•37_b3/1- appli etownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> I�� N Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: REAGE: Elevation of property 3a <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER 0-6 1 D(Ote-' '0753- /_3 <br /> � " * <br /> TOWNSHIP: SECTION: <br /> NW ___51e____ 1/a:__WE ././:___!C-_ Li Driveway p Its <br /> ADDRESS: (state, c nty, : n) <br /> 3)/Z 1.h WC-4W p6,p9, S1aub/rra?V) !di 53 CV/ ❑ Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p • 'C,private) <br /> '13 414 0144a P. IL I i <br /> PROPOSED PROJECT INFORMATION S AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1100 f-r• A-OPT I/ i 7E-51 DI' wsb., WINO P105 /47-0/ed a Wing District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> , This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ` f'ir- <br /> SEWER ❑SEPTIC (new/-xistin, <br /> HEIGHT IN FEET: f. NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetl- :/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: oreland (attachm <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1-1 Ero-onCO. , •l permit <br /> q/(:, 2...*5 3 7 i.a + TOTAL SQUARE FOOTAGE: j (s pe •isturbance, <br /> 2ND FLOOR: 3RD FLOOR: f I access) <br /> 1 s3 W /444246- <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available options. <br /> (Please round to nearest dollar) --0. ♦ ♦ ♦ -► $ <br /> / /"47 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 111-No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes SNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 3IYes Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 2No <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) UYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 71No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -+ <br /> 4,-117 ra/nal <br />