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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME ( <br /> s+ol--�� T• \ CT�� S• \( �Ke�1FJUf II oning Status;CUP; <br /> OWNER ADDRESS (Number,street,City,State,Zip) <br /> t'1 b 11.vt .ti , V . E1XA.i2-ToN ed Restriction; CSM <br /> 4�Z S3S3�I ariance(# ) <br /> HOME PHONE CELL VHONE E-MAIL ADDRESS <br /> (1108 S4-4toct C(.�d 1.1S-q8tk1 , •' ••s.xps-+w.•Cow Site Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an includes dimensions <br /> AG T NAM / CONTRACTOR NAME <br /> i\ic V) "Sosr U couST.ISEUskitDCARLPY ❑ Plan including location <br /> AG ADDR SS CONTRACTOR ADDRESS O well/septic <br /> 1s8 G-c.EDI~. tLD. <br /> (City,State,Zip) (City,State,Zip) ❑ etbacks <br /> EDGE, ToN 1 W= 3'S3k4 <br /> PHONE PHONE ❑ S'te Pla proval from <br /> ((c 8) "11`1 - 003b p JDlble township. <br /> E-MAIL ADDRESS E-MAI ADDRESS <br /> N A oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro e <br /> PARENT PARC NUMBER: CURRENT ZONING. G 'ACREAGE: p p <br /> ❑ PARCEL 0oa 0s Q. 3\'1-t1at-a Atk-s s Cj ll s.1 AC1 ,S frontage draw scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> P�trtltaly 3l 1%: W W 1/41/4: _R i �,.,• ❑ Driv ay permits <br /> ADDRESS: �� ate,county,t n) <br /> \1a 'N‘.Ja-S'.t'Z tt..U. EMA.1LTot`1 , 1,a1. `3531. ❑ Sanita ermits <br /> CSM: / © ,� ^ LOT ( SUBDIVISION BLOCK/LOT (pu c,private) <br /> PROPOSED PROJECT PROJECT INFORMATION " TAFF REVIEW <br /> PROJECT DESCRIPTION <br /> AoDT_T2o1JtaL-• tIONCAftD C--A1LlA►Gf�. )< k�( ning District <br /> V O <br /> . L''TThis project is a new building or structure. Permitted Use? <br /> ❑This project is an additio /alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: O Rural ' •• ., <br /> ❑SEWER SEPTIC 1.101, — (newhxisting <br /> Gdimensions HT FEET: t1'Lr 6Rat,,.p TD so FTT NUMBER OF TORIES: (Not including basement) <br /> / ' 6" 1>>o►ar`.NO T� Q.Wetlan loodplain/` <br /> -Sh%r- and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> including unfinished area,attached garages and above grade decks or porches) In -rosionControl permit. <br /> BASEMENT: 1ST FLOOR: <br /> N1 A 100 TOTAL SQUARE FOOTAGE: '(sl _s,disturbance „(-- <br /> 2ND FLOOR: 3RD FLOOR: lltaccessj <br /> )c)S......)."*Ar+LISPACE.1•Sroct,Mte. ((CZ S <br /> - eviewLocation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / 7 © © ® r and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? L'7Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? C''7Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LEI Yes ❑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) ❑Yes LINo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes tl No <br /> J �� <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br /> 4w (,■1-�Z,.. N 3-ClewNS\S.P a.111\al) T4NI. v-ift, '�PF.AK. To 'DAN Q_. Cov4T' MST. <br />