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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 /> V l D 1 S e'""' i 14..5.5wva. ky� ❑ Zoni g Status; CUP; <br /> OWN ADDRESS (Number,Street,City tate,Zip De d Restriction;CSM <br /> `� �u c.l V lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> V q`46 - ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENt NAME COOTRACTOR NAME <br /> t Iite e2rv"■, At1-,'4"--- S' a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 1-3 c-r y 5 <br /> (City,State,Zip) (City,State,Zip) // Setbacks <br /> U"/-E. `CO l�.1 <br /> PHONE PHONE ❑ Sit Plan a val from <br /> ie PS Z73-7%Co/D a plic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS /� <br /> -rwc-( �Q a1 a c p,,K loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.44s/) Elevation of pro pert <br /> PARENT PARCEL NUMBER: CURRENTZkl-1 /ING: ACREAGE: p P <br /> ❑ PARCEL ©�OG'. 0 1� � 10 _� 7, ?.g frontage drawn scale. <br /> NUMBER <br /> TOWN P: SECTION: <br /> r 1/41 • SE ❑ Drivew permits <br /> ADDRESS: (� ` (St county,tOW r <br /> CSM: 7 LOT SUBDIVISION BLOCK/LOT ❑ Sanitary•-rmits <br /> /'� ( (pu, ' ,private) <br /> �p l <br /> PROPOSED PROJECT INFORMATION IE: lE <br /> PROJECT DESC-IPTION: <br /> . � �s �. '�Ck Ga 0 s o ,, s m <br /> . ❑This project is a new building or structure. 1-:;:-F <br /> This project is an additio /alteration to an existing building or structure. T <-'_.q_ -_ <br /> SANITARY SERVICE: PERMIT NUMBER: _ !-- "--' <br /> D SEWER EPTIC - - ii 8 <br /> HEEI i IN FEET: <br /> NUMBER OF STORIES: (Not including basement) `_ ° <br /> AREA TO NEAREST SQUARE FOOT: s tip <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) D _ i <br /> z <br /> BASEMENT: 1ST FLOOR: �: _ � - <br /> �� S-6 0111 4, TOTAL SQUARE FOOTAGE: j 'r r • C r <br /> �O c <br /> 2ND FLOOR: 3RD FLOOR: � # ' <br /> ZZ(o : .3-f X46 <br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ .4 ♦ ♦ $ D 0 A i� -,eg�0, <br /> (Please round to nearest dollar) •p ��� ,; , , ,_' „t <br /> J � � <br /> Jv)ii; Q' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes � o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 'es UdNo ,�Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? (._,i I oe' ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 2'No <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) 'es 'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Ye r4610 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />