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t 1 Gox -r7S,- '7-1- S 1 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> rli: •ERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ow -"AP ,�1 2 <br /> ►t IC ✓ d•- f Ic,11J4li`& 6e'i�!'ti�` Zoning Status; CUP; <br /> OWNER Auuntaa ��.� t, _..,,-----• <br /> �„9 3 a i,� E U n I �d.r, W 5 s� Deed Restriction; CSM <br /> l� r� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6eb-61,3 -344f ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION 41nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Kri Cvst 67741, %...Y 40 Site Plan including location <br /> AGENT ADDRESS CON CT ADDRESS v of well/septic <br /> gge t v Eti. Pi <br /> (City,State,Zip) (Ci te,Zip) �� S3 5-13 Setbacks <br /> I�+J/-d. )�j <br /> PHONE PHONE Site Pla approval from <br /> _6ci _96,35 ppli le township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Ci\Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) w Elevation of property <br /> PARENT PARCEL NUMBER: CURRE TZO)NING: ACREAGE: <br /> ❑ NUMBER d10waL105 7(a k-1 ,y.ib frontage drawn to scale. <br /> TO IP: SECTIQ'I: <br /> a '/4: S '/4'/4: /Ii Drive ermits <br /> IS n'R-b�'�� (stat nty,town) <br /> ADDRESS: <br /> '3D_ J tom- o _)13anita •- I its <br /> CSM: LOT SUBDIVISION BLOCK/LOT ubll. prly 1 /--- <br /> 7 stek.L-44 E s begs <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> fO-rn r Pa •,en AMt/ht.4h 4 6),e 1r 4-C4 /Ctvi / 0 r•c Z \ oning District <br /> . CI This project is a new building or structure. L P rmitted Use? <br /> Phis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural Address <br /> ❑SEWER ASEPTIC ne ---Trig <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> dO / tland/Floodplain/ <br /> e an ttachmen#) ft— <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR:��''� 4.`7-4. Er• I�'�C•• of permit <br /> `"�O 1 t v J'\ ' + TOTAL SQUARE FOOTAGE: ,' (slope-, •isturbance, <br /> 2ND FLOOR: 1 3RD FLOOR: full' /aCC .$) <br /> I / C Q eview Location ey <br /> ESTIMATED CONSTRUCTION COST: oo , d available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ -'1. $ qo� 00 P <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? ❑Yes ❑No &Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? l4Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 21No <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 4L Don't know <br /> 7. Is this to correct a violation? ❑Yes s-No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />