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• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �,1 Q H iv .M• R LA P CZLH . ❑ Zoning , UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) '\ <br /> 7 Z3 SUMMERF:E LJ) IJ R. /Th1 bLETON 10T estriction;CSM <br /> ariance(# ) <br /> HOME PHONE ' CELL PHONE E-MAIL ADDRESS / °7 <br /> g� 0�� J (g G_._ Sit Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NA E (� CONTRACTOR NAME <br /> ao. t Q dR CI I Sb IA C_I-IRT5 Mbon.44LOSO0 Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 3 Au4.hEM`f ST- <br /> (City,State,Zip) (City,State,zip) WI C 2 Setbacks <br /> PHONE �"'� " ` PHONE �� 13 J 35"7 2_ ❑ Si a PI royal from <br /> bog 95-7 -17 I Z 'cable township. <br /> E-MAIL ADDRESS E-MAIL ADD-ES 11� <br /> we31s/-1 / horrid I m CC <br /> h - fl P Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT NING ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL ©-1011 .V 919 011-1(0 frontage drawn to scale. <br /> NUMBER 1 iryprt.,x l a ekt <br /> TOWNSHIP: SECTION: <br /> ,M I b DBE To N I `I '/4: N E , 1414: ❑ Driveway permits <br /> ADDRESS: \ (state,county,town) <br /> 772-3 5urrrhLeFtELb LQ, A4'DBE to",, AJ-L 535 z.Z LI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> SAuk PrESr4 34 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Poo o L S i+E L I E 2 i;) 7< a ❑ Zoning District <br /> Ei This project is a new building or structure. <br /> ❑ Permitted Use? <br /> LI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER CCEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 0 I ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT sr FLOOR: ❑ ErosionControl permit <br /> ll 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> I filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► -► ♦ and available options. <br /> (Please round to nearest dollar) $ (p t 0 CO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes UNo LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? in LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®,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) LI Yes allo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes fd.No <br /> / / / APPLICATION MUST BE SIGNED <br /> sas-,iz(4/08) (Continue on Back) —► <br /> 4 cp / ___ <br />