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•s ` , <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofidane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C‘ s-t �eC 6,,V-i.3 ❑ Zoning Status; <br /> OWNER ADDR (Nu ber,street,city,slate,Zip) D ed Rest' on;CSM <br /> S$�lb tflsPeC`-t��f' l-0��e, (1'lCLL* it k)1' S 3 SS 1t aria # ) <br /> HOME PHONE CELL PHONE E MAfLADD ADORES <br /> �Il.: a ! �; - -.9 l3 to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> $�t� <br /> S.e Plan including location <br /> AGENT ADDRES CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) �� (City,State,Zip) etbacks <br /> PHONE PHONE ❑ Site Plan proval from <br /> Poor ica e <br /> township. <br /> laE-MAILADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION •(http:/Iaccessdane.co.dane.wi.usl) Elevation Of ro e <br /> PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE: P P rtY <br /> ❑ NUMBER j 't� -(9 4 ? o \' a frontage drawn to le. <br /> TOWNSHIP: SECTI �-(� <br /> 1/: , L 1/1/4: [� ❑ Drivewa ermits <br /> �lxr1 PCOIt��e `� (stat ounty,town) <br /> ADDRESS: <br /> S Pt'4S 'Ci f t-O (, (�Z s3 SS 9 ❑ Sanitary :-rmits <br /> CSM: LOT sUBDNI • BLOCK/LOT (p bl' ,private) <br /> • <br /> PROPOSED PROJECT INFORMATION, "" <br /> PROJECT DESCRIPTION: <br /> . �This project is a new buildin or structure. � <br /> ❑This project is an addition/ Iteration to an existing building or struct e. <br /> SANITARY SERVICE: PERMIT NUMBER: a ,:!ft-4°z <br /> ❑SEWER SEPTIC �V <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> l► , c Ian-. ., <br /> AREA TO NEAREST SQUARE FOOT: } ""g � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ,, is <br /> i X, j TOTAL SQUARE FOOTAGE: j $ E t <br /> 2ND FLOOR: 3RD FLOOR: <br /> tl,O }ZOOM*E. <br /> ESTIMATED CONSTRUCTION COST: <br /> — <br /> (Please round to nearest dollar) ..+ <br /> ♦ ♦ ♦ �t� 4 . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ID yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ca No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El ❑No <br /> 4. Has there been a zoning hermit issued for this property in the past 5 years? Cayes ❑No <br /> 5. Is this project associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? {see reverse) ❑Yes lNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes INo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -• -► <br /> 545-112 14/08) <br /> ,...__(( .S ? 1 <br />