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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 <br /> J 0Q1-1 OS6e.r3 f2(Zoning Status;CUP;t- <br /> OWNER ADDRESS (Number,Street, ity,State,Zip) Deed Restriction;CSM <br /> 5- 20 G0�-�) I Kd , W (,rer)0' WS S3S9V Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Nat COS.-3 3 g-3 u3 I ..)er,,vbI 4 t. eil o+�-+, 1 I, Con. :/ Site Plan drawn to scale ig <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic(City,State,Zip) (City,State,Zip) Setbacks /io/'5 <br /> PHONE PHONE <br /> X.Tte Plan approval from/ A, <br /> pplicabletownship. ,SVJ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 04 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) '� Elevation property <br /> PARCEL NUMBER: CURREN on of eft <br /> ZONING: ACREAGE: P P y <br /> ❑ <br /> NUMBER 0 /OS 1 I —)1y-7/So p - / 1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> .5L1 h e p r 0L i Ir j e I '1. '/a: 3 £ '/4'/a: S E Driveway permi <br /> ADDRESS: ii (state ty OWn) <br /> .S 0 3 8 CO 5 -t'p r L• CI Sanitary permits <br /> CSM: _ LOT ICJ SUBDIVISION BLOCK/LOT D ra kr's tao od s (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> 5 h q )e— Fa_►,,r► 11/Y H 4 hi Q- y" 1 /\. )4 Zoning District — 1 q / 4 <br /> This project is a new building or structure. Co y J2k,7�) 0 <br /> Permitted Use �J'�Q <br /> C7 This project is an addition/alteration to an - .-tiding or struc /' /� <br /> SANITARY SERVICE: ERMIT NUM R: ddress <br /> 1:1 SEWER SEPTIC - (7 j 2j. new xisting) 5.e...> <br /> HEIGHT IN FEET: • :ER OF STORIES: .• •. .. • easement) /F' <br /> 1 Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Q ErosionControl permit / <br /> �/ + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, V <br /> filling/access) <br /> 2ND FLOOR 3RD FLOOR: FOOTAGE: 4 t <br /> 1^vl ( '2 Review Location Survey /i/ 4- <br /> EST MATED CONSTRUCTION COST: nd available options. <br /> ���'VVV <br /> (Please round to nearest dollar) "♦ ♦ "� ♦ '� 3 o bJ 00 . b 0.- 6 <br /> P <br /> 76 CI( <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes YiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes SNo ❑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? ❑Yes /4No <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 gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ')kiNo <br /> T_����' % ,o <br /> APPLICATION MUST BE SIGNED <br /> sas>>2 Faroe) �v�t� r (Continue on Back) ♦ -► -+ <br /> c1 r • <br /> I, •,�, <br /> / 'Z <br />