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SUPPLEMENT_to'Web App#' <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION;: = ,.:: CUSTOMER TO PROVIDE <br /> OWNER NAME /� / /� / <br /> 2 � t7r4y /10, e?/es-A z' /lam°'i9 C ze j DSO / El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, tale,Zip) Deed Restriction;CSM <br /> e?a4C S, Iva n P c/ ✓14(1(i Sun w I S-3 70 r Variance(# - ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • (cn�-R01 8'997 0 Site Plan drawn to scale <br /> AGENT INFORMATION, `CONTRACTOR,INFORMATION'``;:,E , , .`, and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> C4/71( C'oA ['Site Plan including location <br /> AGENT ADDRESS r CONTRACTOR ADDRESS of well/septic <br /> ".6°", / 0/ J1J - <br /> (City,Stale,Zip) (City,State,Zip) O Setbacks <br /> Griy)-, Age A„ s.,,_c97 <br /> PHONE PHONE O Site Plan approval from <br /> 602?,.j-77-- /94/j" - applicable township. <br /> E-MAIL ADDRESS / E-MAIL ADDRESS • <br /> (> -.s.gC,i_,f cou4`'omr'1.L�21 O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (tittp/laccessdane co;ldalpe wi use-` ;j _ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: O Elevation of property <br /> PARCEL �7 frontage drawn to scale. <br /> NUMBER a'6 C7 7�- 277/- 23,/iO-' <br /> TOWNSHIP: SECTION: <br /> S c dh/e /N L" Y4: S F WA: a 7 ❑Driveway permits <br /> ADDRESS: v _y �Q `" (state,county,town) <br /> / r l�- 0E-- O Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION . _= STAFF iREVIEW <br /> PROJECT DESCRIPTION: a0.--?u.';''-:',1.1q•4-,c;::. <br /> 8z,//e/ r 77/04/.)Lo -U Zoning Distract f/ <br /> f s <br /> .lThis project is a new building or structure. ` x 'e F" <br /> Permltfec�Use? 1 <br /> ['This project is an addition/alteration to an existing building or structure. - 'A Ntg4 ' <br /> - x r' <br /> ® RuralAddress�� <br /> SANITARY SERVICE: PERMIT NUMBER: - <br /> [ EWER SEPTIC /,?.— -2017-- COOc. T (new/existmg) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 7 Pe Ql' ❑ Wetland/Floodplain/ <br /> Shoteland .(attachment) -i <br /> AREA TO NEAREST SQUARE FOOT: t4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) J® -.M - F <br /> BASEMENT: 1ST FLOOR: 'L -S_C RrosionControl plermlt <br /> . s rw <br /> / , TOTAL SQUARE FOOTAGE: + " -slopes, ll turbanCe <br /> �� �`�y .5-Z 1 T filler gtacce $53 <br /> 2ND FLOOR: J (�'� 3RD e6R:- ,r, 4 `. ,+t, r*ex- { ' rar <br /> /� ez2 / V �� - -`t 1x- . -r '�v:...a. ' - <br /> fl Rewew:L}ocation Survey <br /> ESTIMATED CONSTRUCTION COST: a ��} ' <br /> ���1 �� /) and available opbons� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ U y 4t t ___; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes EiNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes to ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ 'es ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Oyes EINo <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) LJYes ONo ODon't know <br /> 7. Is this to correct a violation? QYes io <br /> APPLICATIU BE- IGE <br /> (Continue on ON Back)MST ►S-►N-i D <br /> 545-112(4/08) <br />