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1-31' � i SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com pp <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS AME_/ tf <br /> i'V 4 ft' 1 L ' D(so& ❑Zoning S atu • P; <br /> OWNE A DRESS (Number,Street City,State,Zip) �p <br /> ��� 1�,-S 4�Z it.w Deed Re tr' ion;CSM <br /> Variance( ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5( i°X13 3 i (R <br /> rolsp _ lado Q ■ • 1 cco, ❑Site Plan drnwryt6scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include imensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cor rocbti ❑Site Plan incl ding I tion <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> It) -Iii 15 Re;es, LK, <br /> (City,State,Zip) (City,State,Zip) ❑Setlpcks <br /> -4v.. ,mo,-, LA 6351/1 <br /> PHONE PHONE ❑Site Plana r m <br /> ¶ o— (91,4 —304 applicably to p. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> w w W 21, , etr,, ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENITZONING: ACREAGE: ❑Elevation of property <br /> ❑NUMBER 0112- 23'4 — 1?!- z 5 8413 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ,11 - 4 Z.3 y.: low '/%: S F El Drive ayp its <br /> ADDRESS: • (state, o ty,town) <br /> CSM: LOT "'fair SUBDIVISION BLOCK/LOT ❑Sanita pe its <br /> (public, ate) ir <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPT N: <br /> }�cost_ ❑ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER RTEPTIC (new/existing) <br /> HEIGHT IN FEET �, f NUMBER i OF STORIES: (Not including basement) <br /> Q` �y ❑ Wetland/Floodplain/ <br /> ( i 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: ❑ EroStonControl permit <br /> 1-7 to -31 412. + TOTAL SQUARE FOOTAGE: ,+ (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 1+1 I 2 . , ❑ Revie o,ri'6 . .urvey <br /> ESTIMATED CONSTRUCTION COST: d� n ,/8 and a ti - O lions. <br /> (Please round to nearest dollar) ♦ --► ♦ ♦ --► ♦ $ 26`1, %., ..-7 `f <br /> ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes EINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies alo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies Ilivo <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) Ekes ►a • ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [I ,• <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -- <br /> 545-112(4/08) <br />