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SUPPLEMENT to Web App:#;ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROP _ z ,'% ,"1.: L CU'.TOMER TO PROVIDE <br /> OWNER NAME <br /> RYA w b_ f R-� 7 I oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 3(9 f Co u NT r f )4 L J ee Restriction;CSM <br /> Va ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • (063-i?f- 4 f r>t i. re 79 - /144/"/CAA/ ite Plan drawn to scale•AGENT INFORMATION CONTRACTOR_INFORMATIiINy; •:$ , +`, nd • cludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sit Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,Stale,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Si Plan -.proval from <br /> a .iik. _.le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> .or plans to scale <br /> PROPERTY/LOCATION INFORMATIO N (httP/laeeessdarie coaane w use `kr <br /> PARENT PARCEL NUMBER: CURR- ZON G: ACREAGE: . ■, .levation of property <br /> ❑PARCEL Q(p0'i—OZ 1_Gila--0 2. 6, rontage dra o scale. <br /> NUMBER L <br /> TOWNSHIP: r SEC N: Ai <br /> S (¶ (L.t N EI p,q-L %4: f v %IA. n) ❑Drive y permits <br /> ADDRESS: (:) ( �� (�^ J (s e,county,to n) <br /> l `(t r� W <br /> El Sanitary =-rmits <br /> CSM: LOT ( SUBDMSIO)BLOCK/LOT .ubl' rivate <br /> private) <br /> PROPOSED PROJECT INFORMATION n -!; i 1 STAFF REVIEW r; <br /> PROJECT DESCRIPTION: , <br /> Ina Id a lab' 1■ :'I oning Distinct <br /> . ❑This project is a new building or structure. NI 44-7' `"' ?� rt <br /> Pe(`mltfed ▪ : <br /> rThis project is an addition/ Iteration to an existing building or struc ure . 'aT r� s ,� <br /> R r .. xc r `7�L. <br /> Rural ddress.� <br /> SANITARY SERVICE: PERMIT NUMBER: t(� 1 ;� :,ti„�� --{� t J . <br /> EWER EPTIC CIIeW/e IStlflg - • s <br /> HEIGHT IN FEET NUM R OF TORIES: (Not in ding basement) °44 1-- <br /> Se `•1 o F7- ❑ .vvold/FT dplajk - <br /> horl .(attachment) ,, <br /> AREA TO NEAREST SQUARE FOOT x,� " n C-4.?* , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> °0 ErosionControl • • (' l BASEMENT 1S FLOOR: <br /> ;_ e ( 4 TOTAL SQUARE FOOTAGE: j <br /> / j`t VV :::7-ali!!!ifil;Lt!t!!!!! N 2ND FLOOR ! `�! >[ 3RD FLOOR: 7 �'I f t T 4e „ -.si <br /> _ ._- ...Z` P°�'`� =.i foe ewJLocation Survey <br /> ESTIMATED CONSTRUCTION COST: $ () �1 - and available options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ •p 10 Cl ti.% E� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies , lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes y: . ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ffe o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes ON <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (Ieav blank• none) <br /> 6. Is a location survey required? (see reverse) s o ❑Don't know <br /> 7. Is this to correct a violation? es ❑No <br /> APPLICATION MUST BE SIGNED <br /> /;\). } �� (Continue on Back) —► -+ <br /> 545-112(441:18) ' ! <br /> • <br />