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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 p <br /> art vs p-iao S�-+ L `,(35"�0 /;■ Zoning Status; CUP; I <br /> OWNER AD S Number,street, ,State, seed Restriction;CSM ' / <br /> t of�< (2•A - _cU�r P a1(Le Variance(# ) <br /> HOME PHONE ,0 ��CELL PHONE (e 0 E-MAIL ADDRESS <br /> - on Site Plan drawn to scale 1 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions �■ <br /> AGENT NAME CONTRACTOR N4M i <br /> 'j 'tj_ii--i-s U chbA, L.Lite Plan including location 1 12,511 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3aIq buu- _(id- <br /> (City,State,Zip) (City,State,Zip) a I Setbacks6�3 Z i SS <br /> PHONE PHON OSite Plan approval from <br /> ( IE Q -- G1.a5— (o 181 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS i <br /> �Lr ' e ' I l�I"t',.,. C� M K Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acceosdane.co.dane.wi.us/) Elevation of property P <br /> PARENT PARCEL NUMBER: RRENT ZONING: ACj A(E: p p y <br /> ❑PARCEL ON _2 IN_ 9-40 cic,A, ;, /l1J frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT N: <br /> 2 u � v v y/ ,/ 1/1/ �[ riveway permits <br /> 11 4: s 4 4:s <br /> ADDRESS: �/ tit) (state,count o <br /> 3a 1 Lk ' r '-+2-c � LA4/I ( ►e W u4 • g.Sanitary pert its <br /> CSM: Z 5 8' I LOT / SUBDIVISION BLOCK/LOT (public • g. a. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DES <br /> � -C V Nvcl`�`w \ Z/,) X /V ' O /'I it Zoning District A ~) <br /> . ❑This project is a new building or structure. j Permitted Use? V C 0. <br /> This project is an addition/alteration to an existing building or structure. /4 <br /> SANITARY SERVICE: PERMIT NUMBER: C .-RUrai . ` -`ss fi y� <br /> EWER �I Y((�EPTIC S�fN -- I y J W 14 (new/;rl4sli� ) *' f <br /> HEIGHT IN FEET 1 NUMBER OF RIES: (Not including basement) <br /> a.1 k C„ „ I/ oodplain/ j <br /> t V �u�r\ S reland ttachment <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached arages and above grade decks or porches) <br /> 2/ otra.,ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> 1 TOTAL SQUARE FOOTAGE: , (slopes,disturbance, 7 <br /> 2ND F 00 : 3RD FLOOR: <br /> filling/access) /Y� <br /> z<6 s <br /> 1 ECRev iew Location Survey <br /> ESTIMATED CONSTRUCTION COST: -4. -4. and available options. , <br /> (Please round to nearest dollar) $ ",9-op 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑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 o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if non <br /> 6. Is a location survey required? (see reverse) ❑Yes o Don't know <br /> 7. Is this to correct a violation? ❑YesVo <br /> 46 Z v APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► -♦ <br /> 545-112(4/08) <br />