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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 /> -"i / 741.4.1., &&' ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 01741:, Gtl/< e© 2/2o4.a 5,70 4rTpiJ S3 6g`c", Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7'7 a/-9- 5 Z/407- ✓andJ Hw9e9 il-ez'-,---. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> LA1G� ..C.D€ll73 m - 1Q-A-.Drkag:tfrIO [ ae770,1/ ❑ Site Plan including location <br /> - <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> .50,4g Po,42/ 23471 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> sa 41 C-07,7/b,:f L �i.� . 3S2?- <br /> PHONE PHONE ❑ Site Plan approval from <br /> 5 --Cr{dS-- 5- �--f D5- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c ea cool 'a.-' . lijj C Ca:2/. Cowes_ ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL b(d/-^J -43 72,e7 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 7 r.5t 2-,,_C /Z .1/4.A/A- %.,,,,: ❑ Driveway permits <br /> /, , _ (state,county,town) <br /> ADDRESS: ZVG a /�,LGWI'ra �� sTOGZG�TaA/ 35- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> l2 5w..41 ,1/4LL- (public,private) <br /> PROPOSED PROJECT INFORMATION +, TAFF EW , <br /> PROJECT DESCRIPTION: <br /> ©Zoning District <br /> . ❑This project is a new building or structure. <br /> � perltted Use,w <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ' o° <br /> (SEWER SEPTIC , ,(�/97'1? ew '� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / ,1 0 Wetland 900dinf <br /> Shorel ) <br /> AREA TO NEAREST SQUARE FOOT: a <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) u , <br /> Ero� , a1 Wit... <br /> BASEMENT:,/� 1ST FLOOR I TOTAL SQUARE FOOTAGE: } f ++'";; ist ,, <br /> 2ND FLOOR: 3RD FLOOR: <br /> Ztd0 <br /> C3 Review on <br /> ESTIMATED CONSTRUCTION COST: 6 CVO, anit-dAitile o <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1=1 Yes g No ❑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? .: 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 /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -p <br /> 545-112(4/08) <br />