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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE O Y <br /> OWNER NAME <br /> NE <br /> /// 477-/)/ Or_OtiiN6L Zoning District It..-- <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> /e2-40 DAA,E.A/VAL.E /C[) AAQS)1A-G- IA'' 53659 /Permitted Use? OM -I- <br /> PHONE E-MAIL ADDRESS „S <br /> 608 ZLS- VIrygo !' Zoning Status; CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction;CSM 'c/1/ <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 3z.,-744 GT5/f/K/y A�3 Site Plan drawn to scale <br /> and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> t- / ",,' -' 1"/i S3 fS8 ,Site Plan including location ?X& <br /> PHONE PHONE of well/septic <br /> oB•z ADDRESS 53o� a 7 2/3Z� �5e /P <br /> E-MAIL ADDRESS E-MAILADDRESS Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accescdane.co.dane.wi.us/) OA Site Plan approval from 4 <br /> PARENT PARCEL NUMBER: ZONING: A. ACREAGE: <br /> ❑ PARCEL _ 5, 3 applicable township. i <br /> NUMBER <br /> TOWNSHIP: � SECTION: r <br /> Rural Address <br /> 'j J. P74/12_/�__ '/: /'/4: <br /> (new/ ,) <br /> ADDRESS: <br /> ❑ Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Z S'f''4 A/it/AN V4uey ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> 7 't " X/5 b K X.Driveway permit-As, i <br /> 9.— <br /> ❑This project is a new building or structure. (state,count ,tow At/f <br /> ®This project is an addition/alteration to an existing building or structure. �. 4,_ <br /> SANITARY SERVICE: PERMIT NUMBER: �) Sanitary,!..-.•••'tS /�� <br /> ❑SEWER SEPTIC <br /> (publi-__` . iii <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) /Wetland/Floodplain/ <br /> /0 Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)p'ErosionControl permit r�jt ' <br /> BASEMENT: 1ST FLOOR: V! <br /> j TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, r <br /> filling/access) Ai <br /> 2ND FLOOR: 3RD FLOOR: 2_2—e) `� <br /> 4Review Location Survey n <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ CO and available options. /v /'� <br /> (Please round to nearest dollar) $ "600 . <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. There is a wetland or floodplain on or near the property? ❑Yes N No ❑Don't know <br /> 3. Have you talked with the township about your project? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes GitNo ❑Don't know <br /> 7. Is this correcting a violation? n ❑Yes ZI No <br /> 4 21- oro APPLICATION MUST BE SIGNED <br /> 545-112(iios) (Continue on Back) -♦ -i -+ <br />