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, (0/f(t-td <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Po 6 'R C- 2b ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1 01_4:30 C TN Y MAZomixt•- E •L- S35(00 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> 715-1 L -I 1008-3y7-13$b robs(t Okar'L dc, cti I•"M ❑Site Plan drawn scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include mensions <br /> AGENT NAME CONTRACTOR NAME <br /> N / 14 I A ❑Site P4in iy luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ ptic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks !o .. I ' 6,) <br /> PHONE PHONE ❑Site PI p p v from <br /> applica tumid. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ��� <br /> ❑Floor pla to tale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation o p petty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 034/64010 223-gt309-b 2N -1 'Z,Z frontage dr n to scale. <br /> TOWNSHIP: SECTION: <br /> MP2.0r+•At•-ri-E 2Z '/4:iogN WA: P-13 ot -e ❑Drive p i <br /> ADDRESS: (stat y, own) <br /> %o2(Q0 c- n y ❑Sans - -dim" <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I21E1 l (pu• I , r a ) <br /> PROPOSED PROJECT INFORMATION 11""J'''' -' ` _ <br /> PROJECT DESCRIPTION: 1," <br /> Yog-TP•6LE U. t-n: s k4 E-p ordn0 tip= <br /> . <br /> This project is a new building or structure. <br /> 111 -. a <br /> ❑This project is an addition/alteration to an existing building or structure. "'- -� q �1' <br /> SANITARY SERVICE: PERMIT NUMBER: f - °' a <br /> `EWER SEPTIC 1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) . ? <br /> I (19f • , <br /> AREA TO NEAREST SQUARE FOOT: ';., t r <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) • lfc. • . °; t ._ <br /> BASEMENT: 1ST FLOOR: " � .� '�q . <br /> Zt (�I 1l�± TOTAL SQUARE FOOTAGE s (s , - " ., 7 <br /> 2ND FLOOR: 3RD FLOOR: - Z Zf ; <br /> ESTIMATED CONSTRUCTION COST: 4,0 k �. i, , 'r®- $ <br /> - -► -► -� ♦ ♦ �jdbO <br /> (Please round to nearest dollar) t , k .,xh <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ❑X No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres go ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes I�-jr,',o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ENo <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 Olo ❑Don't know <br /> 7. Is this to correct a violation? [Yes L No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />