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` SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWES, NAME <br /> Ol0. 1.a.11 °f Shea./0. Sal/c&f-f- <br /> Z- ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �� 51pQ Deed Restriction; CSM <br /> 99(5' I.1 KA C1i 1 ►TZaZO {-i variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> •�, 95=988- os-a 3 -%S3 sloe:/a•s.4“.lfzeagkait 1.0 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Ll Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: / CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER V d °(0�� 5�') ° p- f4 - I frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> '/4: WA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION :0 X77 <br /> PROJECT DESCRIPTION: / # ,li l. `t j' <br /> ,❑This project is a new building or structure. :i _.� :d 4 3 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> c .<. <br /> SANITARY SERVICE: PERMIT NUMBER: ,i a . i� ` £ Nrl <br /> ❑SEWER ❑SEPTIC A T .t l � y <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 3 ' il i <br /> OJT 3rd #Al 0 <br /> , s 3 <br /> AREA TO NEAREST SQUARE FOOT: f Its <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,, :; <br /> BASEMENT: 1ST FLOOR: �rf <br /> TOTAL SQUARE FOOTAGE: + °-'° � <br /> No JK,G a ��0 <br /> 2ND FLOOR: 3RD FLOOR: 3 err 3 <br /> N x a/�o , <br /> ESTIMATED CONSTRUCTION COST: �_ § e ; , <br /> --► —► —► ♦ ♦ —► <br /> (Please round to nearest dollar) 3Oô�� � ��r _ „� 'w'= <br /> r---1.- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? litiM LINO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Li 'Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Gi%s ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI 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 L l'Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes liirKo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —+ <br /> 545-112(4/08) <br />