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• <br /> .SUPPLEMENT-to Web•App#` <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PR•PERTYi_OWNER INFORMATION- . 41 <br /> CUSTOMER TO PROVE <br /> OWNER NAME 2, <br /> J3 (y//'t;esc Zoning Status; CUP, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / /�9 c <br /> 66!!// S / ` �( � Deed Restriction;CSM / �v r ./ <br /> HOME /&t Cr PHONE "-,k 'E-MA�LgDDRES©/ri 0., �r Variance(# ) <br /> r Site Plan drawn to scale <br /> AGENT INFORMATION,: :CONTRACTOR INFORMATION:n2Mg and includes dimensions ' 0 <br /> ' AGENT NAME CONTORNAME / <br /> I , �op,1✓.c r',^5 /1e— KSite Plan including location ' <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic 4 <br /> *'i:r9er1 S_ „' 63/3d <br /> (City,State,Zip) (City,Sate,zip) q Setbacks / <br /> �i�^ 1 S 3.c <br /> PHONE PHONE 5 IPA Site Plan approval from <br /> 6 :) - -305-39"(9 :pplicable township. <br /> E-MAIL AD► S /� •DDRESS <br /> �- Floor tans to scale OC <br /> X if ' <br /> PROPERTY/LOCATION INFORMATION (http://accessdane co lane wr usn ,_, s' ( 'Elevation of property <br /> PARENT PAR EL NUMBER: CURRENT ONING: ACREAGE. ^L� <br /> ❑PARCELr. I. Za i frontage drawn to scat . <br /> NUMBER <br /> TOWNSHIP: SECT! jN: E'0IG.,°n %4: S iL %%4: NE 0Driveway permits <br /> ADDRESS J (state,county ow• <br /> 4i, 6 . C/A vcl/ty jp.../k1A. 7 _ <br /> CSM: �_ (public, <br /> LOT SUBDIVISION BLOCK/LOT .•a•. <br /> —. <br /> 1:1;t•]1•kj1,:1:TeN iinl•lT-r,p, • . n STAFF REVIEW :-: <br /> PROJECT DESCRIPTION: _ € <br /> K-,2'1 L/ �' `° Zoning Dlstnct r <br /> )0 his project is a new building or structure. / ..e s d C <br /> 0 L- t PermltfedkUse? r <br /> This project is an addition/alteration to an existing building or struct re. _: '.:rya f?k <br /> Z I T.� G ;�? v'. <br /> SANITARY SERVICE: PERMIT NUMBER L 4/ K 2 (JC/6 Rural A s F. <br /> EWER DEPTIC - (new_ / XIStln <br /> HEIGHT IN FEET . NUMBER OF STORIES(Not including basement) ' r <br /> / �'J,, / . Weil,,. Ioodplain/� <br /> J • .(attachment) _) / -- <br /> AREA TO NEAREST SQUARE FOOT _ _ �,_„? 4-:A?. . <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> rOSIOnCOntr01 permit <br /> BASEMENT 1ST FLOOR 3 P w <br /> 1, TOTAL SQUARE FOOTAGE +, slopeS disturbance i <br /> 2ND FLOOR 3RD FLOOR filiing�access� v / <br /> ^� / -r`,t to t mar i f <br /> Review Locafion Survey <br /> ESTIMATED CONSTRUCTION COST: ,`' <br /> �} /� and avalla.„.o fions <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? ❑Yes 13No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ,®Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Dies ❑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 EINo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -► <br /> 545-112(4/08) . <br />