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SUPPLEMENT to Web-App # <br /> ZONING PBRIVIIT APPLICATION WMN.CCUntyofdane oom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEA NAME _^ <br /> Q rdn 1- /i.7c4. L i5 bWe- ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3 PHONE CELhPHO E-MAIL 6" V XPc SS Su Pr-c a i S f. `3590 Variance(# ) <br /> HOME <br /> 60 2/6— 7'oU ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> E/7a"!r I o✓) 5-fe ve S/ctlf&r ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 532( Voge3 Ed Sav,-te- <br /> (City,State,Zipa (City,State,Zip) ❑Setbacks <br /> /Ad .soil w1. S3'7/8 Sam <br /> PHONE PHONE El Site Plan approval from <br /> 608-838-VynO 608-23?-957 <br /> (c e// applicable township.. <br /> E-MAIL ADDRESS E-MAIL <br /> �i' 'd - 0 e t( cut ct.'9. ,, 5D/Q a P r-- ,e teiNt y, i'cv,7 '.1=1 Floor plans to scale <br /> #7,7 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> EiPARCEL frontage drawn to scale. <br /> . ,: • -1 Q - yC5 �- 1 • - n.—5-'7 r <br /> TOWNSHIP: SECTION: <br /> IN El Driveway permits IR 131—/...5t0 / (state,county,town) <br /> ADDRESS: <br /> 3076 V i ki 7 • P45.5 <br /> ❑Sanitary permits <br /> 7 As rivet Raul S , <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ., E `er <br /> PROJECT DESCRIPTION: tI - ,,' <br /> j5-/1 6intby,0p1 Su„ Roe,i>✓) U " • s " �s' <br /> • <br /> This project is a new building or structure. i ' Ira? <br /> XThis project is an addition/alteration to an existing building or structure. .. <br /> '111 thtVi SANITARY SERVICE: PERMIT NUMBER: ' a TV <br /> EWER SEPTIC Ayi• . <br /> . ' <br /> HEIGHT IN FEET: 1/ NUMBER OF STORIES: (Not including basement) ` :. , <br /> 3 • sir• t e <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> µ ix� , � t <br /> BASEMENT 1ST FLOOR: 3 <br /> 967-L./30 I TOTAL SQUARE FOOTAGE: I . ice, , ��= <br /> T Y t <br /> 2ND FLOOR: 3RD FLOOR: ' '.,` <br /> TILjs 33 2 � <br /> ESTIMATED CONSTRUCTION COST: : t: : . <br /> (Please round to nearest dollar) $ q ti 960 .. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes FjNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves 'lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes _JVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves ❑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) Elves OM ❑Don't know <br /> 7. Is this to correct a violation? :Yes 0t4o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) = = <br /> 545-112(4/08) <br />