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. _ 49 c‘i, 1 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROP j���UER,TTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> Lts9 6 / r /� d Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street, r,Stale.ziP) , v 4mi— c../I. eed Restriction;CSM <br /> ('vCO ' 1- ��Ll Ta3c.9.-7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,...ft <br /> e-t-t$-G/8? 608 . 14, ODE`/ i"oet hlo�hv'e��'uf4/c . CAS 'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION rid includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> s elZ--T Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4 <br /> (City,Slate,Zip) (City,State,Zip) ■ etbacks <br /> PHONE PHONE fe Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS 'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http: !accessdane.co.dane.wi.us ) levationofproperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: lira io drawn to scale. <br /> ❑ <br /> NUMBER <br /> PARCEL <br /> X08-2 8 9-s _O _Ac ff ( /9' <br /> TOWNSHIP: �,w SECTION: • i <br /> m t.` way permits <br /> ��• ��'�`' 'state county,town) <br /> ADDRESS:(/Ca G2 "l thnt'' `1 fo e ,V eY 4'L/ . 53CI, <br /> 7, .anitary permits <br /> S <br /> CSM: LOT SUBDIVISION BLOC OT (public,private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> tZert,o O / Z- C'-zer$77"4.2 er4P14,40cining District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> AThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> El SEWER C1 SEPTIC {A %; (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not inindu ing basement) ❑ Vlletland/Floodplain/ <br /> T 1"C Shoreland (attachment) <br /> AR TO NEAREST SQUARE FOOT: ?5 Z.— <br /> (Outside dimensions including un Wished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEME 1ST FLOOR: <br /> 14,5-1-5- 4-2;2_,4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> T -' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: y, ,_t(�(+2---2-1-1 <br /> �9"�Ti' Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -1. ,♦ ,♦ ,♦ -I. $ Q C� and available options. <br /> -4.(Please round to nearest dollar) c� ©© ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes liKlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes rXNo <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 XNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ki7 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4. <br /> 545-112(QM <br />