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;.SUPPLEMENT to.Web App# <br /> w <br /> ZONING PERMIT APPLICATION ww .countyofdane.com <br /> PROPERTY OWNER INFORMATION :,.: _ -•- ;>- '. CUSTOMER TO PROVIDE <br /> C;NNER NAME/ <br /> / L V, I Zoning Status; CUP; 4 •_. / <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> o2_„co 5 ,4. c s r P g, Variance(# ) <br /> HOME PHONE CELL PHONE E- ■•ILADDRESS�1 <br /> F77 �`35L a d U r 1.IA I%d '40 h/.e vo Site Plan drawn to scale <br /> a.AGENT�INFORMAT IOltl ;. , :CONTRACTOR:INFORMATION_ �{ and includes dimensions /A �� <br /> AGENT NAME CONTRACTOR NAME /'C9 M <br /> C� re, Site Plan including locatio iii <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,zip) g Setbacks& 3/3 O/Z O,/ ) <br /> PHONE PHONE Site Plan approval from Af <br /> applicable township. /4- <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> C<Floor plans to scale <br /> :PROPERTY/LOCATION;INFORMATION':'(httpe//accessdane.co.dane wi.us/) , - I/ <br /> PARENT PA ELL NUMB C RENT ONING: ACREAG / .Elevation of property 7 <br /> 0 NUMBER l r /, 2~ 732i 7 A —l 0, 6 /C frontage drawn to scal . <br /> TOWNSHIP: c , , SECTI N: ' /1/ �_ / ' , �/ Driveway permits <br /> J �” b` pV �i ' r I /a: / / ii /a/a: (state, county, <br /> ADDRESS: S // _ p <br /> ,Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, deP <br /> PROPOSED PROJECT INFORMATION _ �'STAPF"REVIEIIV ,: <br /> PROJECT DESCRIPTION: ( / fJ �`t 3°" �' <br /> r ,( `0 ( < �li S� D , ,.... ),_ S h c GY onilig ipipcf,2�� ' x-;It <br /> . XThis project is a ew buildin• .r structure. _� a Y s `r <br /> Permlfted Use <br /> ❑This project is an addition/alteration to an existing building or structure. b <br /> SANITARY SERVICE: PERMIT NUMBER: ral A. L f_�a-t - <br /> R�ratA.. A1�.� <br /> [ EWER �fJ SEPTIC / <br /> 7,-;...-4,..:,...e.-� w -',''s.• r <br /> HEIGHT IN FEET ` NUMBER OF STORIES: (Not including basement) _ �ki jT <br /> 7 , Wetl t. ?Oo falrl .4 <br /> 3� ,: ire ar�;_ ettac�rlaefl�), <br /> AREA TO NEAREST SQUARE FOOT ' w '�' .A- .. g§' ` . <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) up . ' i--- s- _ <br /> BASEMENT' 1ST FLOOR: .-�.. .1-ten s '� ` <br /> 0`� 5 ,, TOTAL SQUARE FOOTAGE: 4, �pes. I tUr.a{�C F ') / <br /> 2ND FLOOR: 3RD FLOOR: Zu aGC ' �z: d <br /> Y 41 ,'. / <br /> . .2-0 0 elite,Lo'ati n cii9ey <br /> ESTIMATED CONSTRUCTION COST: A , a a[�)eM ti2Pi i!et <br /> Please round to nearest dollar ♦ "♦ ♦ ♦ --► -5► $ 7 C 5 g.. .,y ..__ <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? [Yes ❑No. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eves ONO <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 /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112{4/D8) . - <br />