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SUPPLEMENT to;Web Apps# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION,_ ,. „_ - FI.V_,-,4'..: CUSTOMER TO PROVIDE <br /> o �v Q-� k('C �� oning Status; CUP; <br /> V O ER ADDRESS (Number,greet,CIy,Stale,ZZp) Deed Restriction;CSM <br /> HOME ONE �I\c ?P ONt-� E-MAIL ADDRESS Variance(# ) <br /> e Plan drawn to scale <br /> AGENT INFORMATION :: .CONTRACTOR INFORMATION.a¢ _;t,.;;r and includes dimensions <br /> 'AGENT NAME NTRACTOR NAME <br /> C,v(1 i'4�t-L._ ❑Site ' luding location <br /> AGENT ADDRESS CONTACTOR ADDRESS of we tic <br /> CIS ' K��1--e S L <br /> (City,State,Zip) ity,State,Zip) 111.594<Cks <br /> Si0�)`'l, C IN) S' -..-1444. <br /> u3 . <br /> PHONE PHONE`_ ❑'Site approval from <br /> ���S'1 -- ( 1 ,1 ap ' abl township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> _ F or plans to scale <br /> PROPERTY/LOCATION INFORMATION htt //aceessdane eo da newrus '� <br /> I P� .z— 'i vation of property <br /> PARENT PARCEL NUMBER: CU TZO,Ny�G: ACR E p p dY <br /> El NUMBER O6/0 -c a'90( 11 frontage drawn to scale. <br /> TOWN �-IIP: SECTION: <br /> U J\ , , / ❑Drivewa ermits <br /> ADDRESS:.) p /4 /4 4. (state ou ,town) <br /> r�I0C(t 1J1' ❑San. ... ,ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT GS (pub' , ► ivate) <br /> PROPOSED PROJECT INFORMATION - : w STAFF REVIEW <br /> PROJECT DESCRIPTION: /' 'rh,� <br /> ref'c�CQ. iMG611 ., I4c -k b 0 A(/ �, nin Dlstnct r " " <br /> This project is a new building or structure. * ,S ` ` <br /> rmltfea Use? , <br /> This project is an addition/alteration to an existing building or structure. = `� ,_� a,, <br /> SANITARY SERVICE: PERMIT NUMBS "® Rufal Add ' ,Y ;, <br /> EWEREPTIC (new/e <br /> HEIGHT IN FEET 11 NUMBER OF DRIES: (Not including basement) k <br /> s I ❑ etla •odplai n/ <br /> ; orela •°(attachment) <br /> AREA TO NEAREST SQUARE FOOT: s F a 1 <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t' <br /> 0 Eosj <br /> C o- • <br /> t <br /> BASEMENT 1 STIFL(( K = pe tubance,, TOTAL SQUARE FOOTAGE 4 so sr <br /> ifi fli • a r ssY <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 t i,T k� 7 <br /> .- .. . _ 1 07 �'\ ! rR v`ie1'Lo Ior�S niey; <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and av •te otitlons -, <br /> Please round to nearest dollar) r ,, y, ,5,, + r 4,,ili <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes DVo ❑Don'fknow <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 go <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yeso <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 ?4o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes J "O <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ♦ —► <br /> 545-112(4108) - . <br />