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2P & <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRO <br /> OWN ME A . /1 '— <br /> brUce A�f . 6r;e// Zoning Status;CUP; ;1��GG.,,t \ <br /> OWNER ADDRESS (Number,Street,C , ate,Zip) Deed Restriction;CSM l <br /> g 7/O To t v�r l�d' tit. F r la li itiL .53558' Variance(# ) <br /> HOME PHONE !CELL PHONE E-MAIL D If ESS ( <br /> F33-376a , NQ•O ,0* b ri l• rI// &Ver'zon , ii et t to Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Okte Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �,�of well/septic <br /> (City,State,Zip) (City,State,Zip) K Setbacks <br /> PHONE PHONE I e Plan approval from <br /> ap licable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> — /Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �levation of property <br /> PARENT PARCEL NU BER: CURRENT ZO ING: ACREAGE: VVVV P P y <br /> ❑ PARCEL <br /> UM EL ©�y p NU 6/O-Og3.)/,1V-� _ 3 frontage drawn to scale. <br /> NUMBER 0�Ol(� T ��11 <br /> TOWNSHIP: SECTION: c <br /> Dt)h 0 0 q '/4: 3 Ul '/4'/4: NE. It ►riveway permits <br /> ADDRESS: (state,county,town) <br /> .7/O 7 ver fS)o( �c Fa rla oc (.()r 5-3558' <br /> anitary permits <br /> CSM: LO ji�l aNal 51.001 SUBDIVISION BLOCIVbe� public,private) <br /> 30'Of lot 13 6reehrid,e Potek 5 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3 Season Porch k,caoning District <br /> . ❑This project is a new building or structure. rmitted Use? <br /> C7 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad• - s <br /> 'EWER ❑SEPTIC (new/ <br /> HEIGHT IN FEET: �� k NUMBER OF STORIES: (Not induding basement) { <br /> / ` (t� 0 qe 4letland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: S eland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ErosionControl permit <br /> f(,I q 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 11 11111 access) <br /> �T L4 Review Location Survey <br /> ESTIMATED ED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ©© and available options. <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? YYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0/No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1'No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/a peal# o (leave blank if none) <br /> 6. Is a location survey required? (see reverse) 1613. 1 rc<O.vr .. ^' ❑Yes [No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes LNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ —► <br /> 545-112(4/08) <br />