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• <br /> SUPPLEMENT to Web-App # <br /> . ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> W I - mob,ONEAME I� (y <br /> ��i'l i �(1 / /u 'l C-( ❑ Zoning Status; CUP; <br /> O ER ADDRESS, Number,Street,City State,Zig)c. r/� Deed Restriction; CSM <br /> .)�1k1 ( 'plc t ----t-1 Li- ' fr,i(2-LiA KiL 11!�- fn. . .i.�,i ' Variance(# ) <br /> HOME PHONE CELLIPHONE E-MAIL ADDRESS <br /> f di:- 9k-iii)5`4 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AENT NAM �^ ` CONTRACTOR NAME <br /> JeAVIN6e/ LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5kttii YaVeyi CA 4-1- <br /> (City, wee, l 5'�5°l� (City,State,Zip) ❑ Setbacks <br /> PHONE _ ❑ Site Plan approval from <br /> 53-g�(9-(p&�(e0/.0 8-)1-50►-id� applicable township. <br /> E-MAILADDRE E-MAIL ADDRESS <br /> .■ yg_>�V�-trcx )-to W\ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL DO1 9 D /� 9 frontage drawn to scale. <br /> NUMBER U D Ids" <br /> TOWNSHIP: SECTION: <br /> 5 e i P(3- I 62_1) � ....... ys: S� 1/1/a: f J e ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT ..71 SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATI/ON §.� <br /> PROJECT DESCRIPTION: 1 )- - i/ 4 <br /> • Whis project is a new building or structure. Pew, <br /> LI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: i .x <br /> ❑SEWER 3.2CEPTIC '73 64/07 " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including ba--ment) <br /> .X :. ;-. t) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above •ra•- •-.ks or porches) I" .ary�i° ' ?F <br /> lli� ..t i i <br /> BASEMENT 1ST FLOOR: � _;.'1,:-,1..,_,- <br /> * , /1 TOTAL SQUARE F••TA' : 4, , <br /> 2ND FLOOR: 3RD FLOG : <br /> NA P/A q , <br /> ESTIMATED CONSTRUCTION COST: , <br /> ♦ ■ • • • ♦(� ,I*r <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 f∎Jo ❑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? .'Yes I/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) ❑Yes Ai o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes �= o <br /> AContinuePPLICATION on Back)T MUS BE SIGNED <br /> 54e-112(4/08) <br /> ( ♦ ♦ -i <br />