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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWNER NAME /� <br /> (ova -,4 t e`1 ('A ThX- I 6 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 2 <br /> X32 Edo U J/" / 57-15-2-1 seed Restriction; CSM <br /> l l (� Variance(# ) <br /> HOME PHONE CELL PONE E-MAIL ADDRESS <br /> aKe <4Q `nc '1'w•s 2 C u a Site Plan drawn to - r /6.......,AGENT INFORMATION CONTRACTOR,INFORMATION ' and includes dimensions <br /> AGENT NAME CONTRACTOR NAME // <br /> Ac a w <br /> ti o •c �..),�e5i LL _ Site Plan including location ` r <br /> AGENT ADDRESS CONTRACTOR ADDRESS -_ - /f <br /> -0661 CO"-Ce,°d .D-- <br /> (City,State,Zip) (City,State,Zip) Setbacks oiAO�2-h/// <br /> O/S 0 <br /> :+c_ctb , LZr. S-3 5- 5 <br /> PHONE PHONE 1,Site Plan approval from _ / <br /> ( 6c � 4182. -- oc r. applicable township. Of 4 <br /> E-MAIL ADDRESS E-MAIL ADDRESS / l • <br /> /t'«TT ICEP( '-i7 O i( ∎ek)•cork Floor plans to scale /i''PROPERTY/LOCATION INFORMATION (httpe//accessdane.cod- i-" . <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: . evation of property <br /> PARCEL -�i p frontage drawn to scale. <br /> ❑NUMBER I���jo SU`�',,?7L���{s'�F'-� ?�0 <br /> TOWNSHIP: SECTION �` <br /> --Z_ '/J '/4: JV VV '/<'/4: �►" Kriveway permi : <br /> ADDRESS: (state,county 1! <br /> Sanita <br /> csM: LO '1 su:DIVISIOr C� ,q (publi rivate <br /> Z'1 J S r, Pk w:;:d r< di( <br /> PROPOSED PROJECT INFORMATION STAFF.REVIEW <br /> PROJECT DESCRIPTION: �,/ t� <br /> ( 4c Lcc. AdA.-�-)ok1 tr :14,N [�ATI,.e•- t�cw-04. 1 %Zoning District ` C <br /> . ❑This project is a new building or structure. I ` 4 <br /> Permitted Use <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ufal <br /> rEWER RIEPTIC (ne <br /> ?AHEIGHT IN FEET: / f ® A NUMBER OF STORIES: (Not including basement) <br /> x `� ,,F�1{_ / /[y •a ftabh / ) r <br /> I 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: ErosIOnCOntroJ permit <br /> 4, TOTAL SQUARE FOOTAGE: j slopes dlStUrbanCe I <br /> / fillip-gda-d 5-S) S <br /> 2ND FLOOR: 3RD FLOOR: /6 (y F <br /> a Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ Uc 0 8 4 d� and avatlable options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ •♦ /` / V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes jNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes gpo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies x❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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) DYes ❑No ['Don't know <br /> 7. Is this to correct a violation? Dies W'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i —► —► <br /> 545-112(4/08) <br />