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SUPPLEMENT to.Web�App# <br /> 1 ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER.INFORMATION r . .' . _ °''- : OFFICE USE.O,INLY :! <br /> OW R NAME ` , <br /> V 1 61,3 Oc t c,WrS 1 'ltd C. ❑ Zoning District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ; <br /> a1\O C-D p eS L-.• S6L)Gt-k101•t , wt S-S St it ❑ Permitted Uses <br /> PHONE E-MAILADDRESS <br /> ��- 3' 7 7a S -'- ❑ Zoning.Status; CUP, <br /> •AGENT INFORMATION CONTRACTOR`.INFORMATIONE �. '? �,,, Deed Restriction;,CSM <br /> AGENT NAME CONTRACTOR NAME VarlanCec($ ) <br /> 170>a Q:0e,-t rI91eX <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to Scale.: . <br /> oytat C6,p 1' 3 \--r <br /> an`d rncludes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> ' <br /> n�an , w t S'35 l ❑ Site Planxrcudng ocation <br /> PHONE PHONE � <br /> 41 of well/septic 7 <br /> hole- Si3- -)yl9 r <br /> E-MAILADDRESS E-MAILADDRESS ❑ Setbacks ' <br /> PROPERTY/LOCATION';INFORMATION '(httpa/aceessdane co danew7:us1) ..'' ; .0 Site.Plan approval from <br /> PARENT PARCEL NUMBER: ZONIN ACREAGE: applrCable township 4.4 f <br /> T❑OWNNSUMIBPE: R JQI SECTION: ra Addess # F <br /> Ou0A t inaag r t 5 1� ! ✓ 1�a 14 ' n eW X, : g ti ' <br /> ADDRESS: r� r c s1F <br /> °) L0 LA e \-,n S-6 vG1+T N , LA)t �3S 3 ❑ Ploor ians t`o sCaW - -' - <br /> LOT SUBDIVISION BLOCK/LOT e s F.A r�' ,, <br /> vu 49 `1 S 1�• v! Pi Elevatlon,"of property <br /> PROPOSED PROJECT INFORMATION_ - .. l <br /> PROJECT DESCRIPTION: s . <br /> Cpl x to' ti 'S'b e,r ='®.r lvewaytpermtfis <br /> I�This project is a new building or structure. ( tate,coutaty,$)own� <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ❑ti Sanitary permits" , <br /> SANITARY SERVICE: PERMIT NUMBER: pibNC, rlat '' <br /> a �a a <br /> ,�� SEWER ❑SEPTIC <br /> er <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑',WWtlan'd/FIOOdplaanf, <br /> 2) I Igq:c:ttaata tkit4 achmen9, <br /> AREA TO NEAREST SQUARE FOOT: tu � r , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ E siong�contrrf permit= <br /> BASEMENT: 1ST FLOOR: (S10pP�S,iilsturbalce, <br /> I Q O j, TOTAL SQUARE FOOTAGE: <br /> filling/acrs ) t=k <br /> 2ND FLOOR: 3RD FLOOR: i3 z `rr' 5 £ <br /> (')O ,,I Rieview j,c cation Survey ' ,, <br /> ESTIMATED CONSTRUCTION COST: $ cz and avarlbte options <br /> (Please round to nearest dollar) --► ♦ ♦ ♦ ♦ b <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes El-No ❑Don't know <br /> 3. Have you talked with the township about your project? Yes L3 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes L3 No <br /> 5. This project is associated with.a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ®No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes ©No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br />