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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> • PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE lc( <br /> OWNER NAME <br /> till fa 4-kthred k Zoning Status;CUP; it <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1869 4-likbrkeJ k I- -ex- e-'ol (KY. 535--,s Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> L2C€5 7(04"506• Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONT-•CTOR NAME <br /> 1Q .--e n.k0u„ b.1 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 'N-Nr-Q L <br /> (City,State,Zip) (City,State,Zip) Setbacks 2 Q s/gG 4 d,f," <br /> --De x-Ck.e, LL S3\ . <br /> PHONE PHONE KSite Plan approval from k <br /> ap•li to nshi•: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floo,plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: 1 CURRENT ZONING: P P rty <br /> ❑ NUMBER D I: D1 I I -am-- c o.,,, A • E- rontage drawn to scale. 10 <br /> TOWNSHIP: SECTION: ,� / <br /> 'Loft a e (Of ovQ a3 ,Y<: ,/,/.: t�Driveway permi 'Rr/ <br /> (state coup ,4 ADDRESS: <br /> I ‘Bca.9 IAtl`eAt fir■ \ ze)rQ�`-e\c\ \ S-YD31 . Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> P ECTDESCRIPTION:b Cyr' �' a' <br /> a t r I'. <br /> .7 ti e, I b� i>✓t 4-, L t v K. h` ,�y �1! ,1 �a ,� <br /> • ❑This project is a new building or structure. q--b sr `y z 0 .:- x, , / <br /> dThis project is an addition/alteration to an existing building or structure. y F 71--O <br /> SANITARY SERVICE: PERMIT NUMBER: ,r -° r,-- <br /> ❑SEWER 'SEPTIC is 4� �3 `3 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ` . 4 " � <br /> AREA TO NEAREST SQUARE FOOT: V„0� . 4 :--4:�� 1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) j - ' € <br /> BASEMENT: 1ST FLOOR`. - : ®1f '�� ��> "� <br /> I��fQ <br /> I loo (1+ 1 ID i-r"• 4, TOTAL SQUARE FOOTAGE: .� �;w v a,, r: <br /> 2ND FLOOR: 3RD FLOOR: ' r fix;, <br /> ESTIMATED CONSTRUCTION COST: //J <br /> (Please round to nearest dollar) -. -. —•. -. "'. -+ $ S o(ccu fff <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes J <br /> lNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes 2//No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑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 No ❑Don't know <br /> ,— <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 />