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SUPPLEMENT#o web App# ;ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY:�OWNER:INFORMATION :` " _. _W;:{ n s CUSTOMER TO PROVIDE <br /> OWNER OWNER NA <br /> id• // �r oning Status; CUP; <br /> OWNER•DDRESS (Number,Street,City,State,Zip) ESSS <br /> Deed Restriction;CSM <br /> c.72?(-1 S Z `/ � 1/y, E OW /� �� Variance # ) <br /> HOME PHONE CELL PHONE E AIL R <br /> t'15 j35 "rx'e *Itc-• <br /> Lt CAr4 ,:r ite Plan drawn to scale <br /> AGENT INFORMATION• ._ `CONTRACTOR INFORMATION s . t. � : and includes dimensions <br /> •AGENT NAME CONTRACTOR NAME <br /> El Site I ' luding location <br /> AGENT ADDRESS CONTRACTO RESS Of ptlC <br /> (City,State,Zip) (city,State,Zip) etbacks <br /> PHONE PHONE D Site PI al from <br /> applic a wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> FI plans to scale <br /> PROPERTY./L'OCATION INFORMATION (http//accessdane Co_daneµwr use , <br /> ` `r El ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P p rty <br /> PARCEL <' rontage drawn to scale. �� <br /> NUMBER // -4/ 3 S 0 /6n_ ��1 <br /> TOW P: SECTION: <br /> ❑Drive ermits N f 0-----...,� %: %%: alp, <br /> ( e, c nty,town)ADDRESS: <br /> > <br /> e �� ¢p - 7")(-- D Sanita. _ -rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (s,6 IC, 6 ivate) <br /> .PROPOSED PROJECT INFORMATION „ -- -.4 ; - TAFF-PREVIEW <br /> PROJECT DESCRIPTION: II r <br /> ol� I i , \ , Z ,tng nct <br /> . ❑This project is a new building or structure. 1� Pe Itfed Use's <br /> DThis project is an addition/alteration to an existing building or structure. L .� <br /> SANITARY SERVICE: PERMIT NUMBER: RUriil ' _� <br /> NEWER [EPTIC i�� t (new/ xlstiiig) <br /> HEIGHT IN FEET NUMBER OF ST RI S: Not including basement) Y <br /> ( Lf / O Wetay aln/ <br /> ,� S• and ttachment) <br /> AREA TO NEAREST SQUARE FOOT: ° - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - <br /> BASEMENT 1STFL0 =0 ErasiO ontr• p mlt <br /> TOTAL .. - (slopes l rbance <br /> 2ND FLOOR 3RD FLOOR f„x _.„ . �. u <br /> Review Locate <br /> ESTIMATED CONSTRUCTION COST: ♦ —0. ♦ ♦ ♦ ♦ d vallabie • •ns <br /> (Please round to nearest dollar) C 1 5r4e;, '¢,` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes DNo DDon't k ow O <br /> 2. Is there a wetland or floodplain on or near the property? Dyes DNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes Olo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - [Yes DNo <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 DM) ['Don't know <br /> 7. Is this to correct a violation? Dyes Llo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -+ <br /> 545-112(4/08) <br />