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5 <br /> ���UJ SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWN NAME <br /> (•fin -; (/J, Zwei 1e I l Zoning;District <br /> OWNER ADDRESS,(Number,Stre t,City,State,Zip) <br /> III CI E---N A-z 1 `) ve-cts y c UJ1 5 ��3 eermitted Use? <br /> E-MAIL ADDRESS�5-78°3�c)v- S W 7_1,re%4 �S, fie-+- <br /> oning Status;CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> AG T NAME CONTRACTOR NAME <br /> be 1 v. 7 le-l si _l c Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS Site Plan drawn t0 scale <br /> �s /1)042- and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> pc);3,m w ( S 545- 3 <br /> lid'Site Plar ;including location <br /> PHONE PHONE Of ell/septIo „ <br /> (00g- 2-781 73C)3 <br /> E-MAILADDRESS E-MAILADDRESS <br /> ZWe( ,t• kc w c,( , C o-r✓\ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ite Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: 1 al3pllCi3• ° nship. <br /> L-.1 PARCEL NUMBER 0(0Q"560�-311--w�_V C '/� 3r038( -r. <br /> "°1 <br /> TOWNSHIP: SECTION: N1� -5(J <br /> Mrd Ci ral Address <br /> e -ytl_. 3) 1/4: 51/41/4: ow/existin <br /> ADDRES : �� <br /> I eorLb+ Pro I,;,�d : = <br /> CSM: • SUBDIVISION BLOCK/LOT �, <br /> o� �- 0r .Elevation of property <br /> PROPOSED PROJECT INFORMATION fr°` ntage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> ,� S'�5 le �; Iy Driveway permits Ve4/0 <br /> . This project is a new building or structure. (state,county,town] <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: O/1 (public iv <br /> ❑SEWER SEPTIC `�I � !^� <br /> HEIGHT IN FEET NUMBE OF STORIES: (Not including basement) "41, ,;etland/FIoodplain/ <br /> r horeland.(attachment). <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dim Ions including unfinished area, attached garages and above grade decks or porches) P �j 1�,L it 4 <br /> ❑.EroslonContrperm <br /> B.4ScMENT: 1ST FLOOR: j TOTAL SQUARE FOOTAGE: (s ops:,isturba'f1Ce, <br /> I <br /> a g7� (IgLri filling/access) <br /> 2ND FLOOR: 3RD FLOOR: --•-•' <br /> 9 3 5 5 f 3S „M Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ..+ _ ..4. ..* —0 000 and available options. <br /> ( lease round to nearest dollar) <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yeslo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project? Yes CI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# - ' ) (leave blank if none) �'81 b <br /> 6. Is a location survey required? Yes ❑No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(1/08) <br />