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i�, . CZ 4-200 A ilD 131, <br /> °0 ' _2 '� SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPL1CATION www.countyofdane.com <br /> . h► <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> MAZY I •I At.lD CAr.00 N 5 W EZAt- oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> (AGOG\ CWESTTPJ T b2_\■ E 1 w►NDW2 (A` 53598 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (0043's4t,-ZSlo(pl Lit4e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> TmTM< W GOTZ10W ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ARRZEEI �q a k'E SAD <br /> (City,State,Zip) (City,State,Zip) 99"�etbacks <br /> W taDSot.i WS C 369$ n <br /> PHONE PHONE Y'i a Plan approval from <br /> (i,() - ZO oi - z'i S j applicable township. <br /> E-MAIL ADDRESS t � L F E-MAIL ADDRESS � � <br /> t o\y bt LAav1(S a ro rt S. CceFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vatlon of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: e property <br /> 1g PARCEL OCA 10311 1p S i O 'R— 1 frontage drawn to scale. <br /> NUMBER � <br /> TOWNSHIP: SECTION: <br /> W KDSCA-. '/a: INN: UnVeway permits <br /> ADDRESS: (state,county,town) <br /> G.50 C,NESTIJSi "(Z8.vE <br /> Ok <br /> CSM: LOTS, SUBDIVISION BLOCK/LOT nitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION FF REVIEW <br /> PROJECT DESCRIPTION: <br /> MksTEe `geor.co M Apiw'ricir1 zoo ing District <br /> . ❑This project is a new building or structure. EV'errnitted Use? <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE:yyVICE: PERMIT NUMBER: ❑ Rural Ad• - S <br /> Si del SEWER ❑SEPTIC / (newt= (sting <br /> HEIGHT IN FEET: 7...., J ''V IC) NUMBER OF STORIES: (Not including basement) <br /> t Lo /11 loodplaln/ <br /> A TO NEAR T SQUARE FOOT: Shoreland (attachment <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: rOSIOnCOntr01 permit �– <br /> Sri (o Si' ( l TOTAL SQUARE FOOTAGE: , (slopes,disturbance, 3 - <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ©1 <br /> I Z view Location Survey <br /> ESTIMATED CONSTRUCTION COST: d� �� and available options. Al 0 <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? ®Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? lil Yes LI No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NiYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes t5a 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 te No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ra No <br /> g6 APPLICATION MUST BE SIGNED <br /> 545-112(4/0e) <br /> A,0° (Continue on Back) <br />