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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> iF it aen� A fir`-eS gZoning Status;CUP; C. <br /> OWVNEVAADDR S ( umb-Street,City, ate,Zip) (� / 3 -- Deed Restriction; CSM 5 > <br /> HO,, PHONE ` 'CELL / p- E-MAIL V\ t' 2 Variance(# ) <br /> D I Site Plan drawn to scale n <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions (-'. /".■ <br /> AGENT NAME CONTRACTOR NAME <br /> /11iL mar/ Jib�,yn S h Site Plan including locati <br /> AGE RESS‘ • CONTRACTOR ADDRESS of well/septic ,s,) <br /> W1 ka46-44. 1,4"r(CitK State,Zip) r (City,State,Zip) d Setbacks 2 <br /> PHONE PHONE Site Plan approval from/'l� ti,....406 7/ 8 ( applicable township. L'°� <br /> E-M II •DDRESS E-MAIL ADDRESS <br /> N. <br /> u `A* .o' 4 ' ,Ol• ,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) r levation of property <br /> ,y- <br /> PARENT P CEL U ER URRENTZONING: ACREAGE: i <br /> 0 PARCEL l t _352„2)57 RENT drawn to scal . <br /> NUMBER / <br /> TOWNSHIP: AA r`s SECT N:t�J IA: to/ iAl IA : ZDrivewa - mita., <br /> (state, • town) <br /> ) <br /> ADDRESS:2 Z 7 1 <br /> F ,, S / / 4 1, �� y Sa -■ permits <br /> CSM:/2 s v/ LOT / SUBDIVISION BLOCK/LOT <br /> (•43117,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: t I / 'A/C!/fI 'f r , X Zoning District C'— 2._ SS11/. ❑This project is a new building or structure. � Permitted Use? We. t1 <br /> This project is an addition/alteration to an existing building or structure. c5- N `44 <br /> SANITARY SERVI : PERMIT NUMBER: Rural Ad• - s f AI q <br /> EWER [EPTIC (new/411111M4' `'� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2� t <br /> s / 4 Wetland/Floodplain/ /-11 I <br /> � <br /> Shoreland (attachment)�Nfit- <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit /A <br /> 2 ,, TOTAL SQUARE FOOTAGE: ,j, slopes,disturbance, 4' <br /> 2ND FLOOR: 3RD FLOOR: I filling/access) , . <br /> ibt.2_ Li Location Survey)J <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q --f, /� ) and available options. <br /> (Please round to nearest dollar) $ V V CJ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Llo ['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? Efres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Olo <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 /> 7. Is this to correct a violation? Des Elo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(408) <br />