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ZONING PERMIT APPLICATION www.countyofdane.com <br /> SUPPLEMENT to Web App # �D"v <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Mrs.Carla Augustine <br /> 504 Hannerville Rd Zoning Status;CUP; <br /> OwNERADORE; <br /> Edgerton,WI 53534 Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONEC (�� E�IAl1 ADDRESS <br /> 1 *13 S :sal a q.✓5 t v Site Plan drawn to scale c <br /> AGENT INFORMATION CONTRACTOR INFORMATION and i udes dimensions . t��U <br /> E CONTRACTOR NAME /V� <br /> (�Y 1(� P"-L)u i t1 e, -tee_ �1') -��g�►� Site Plan including location <br /> AGENT ADDRESS CONTRACTOR _1°1313E7/, iif well/septic <br /> yo 1<cl( �) (CIty smm.4) ►= Setbacks <br /> des n 1 63 53`t �- L <br /> NE PHONE �7 5 'ite Plan approval from S—13 SO4- rra" <br /> �� evo���� -'73�- applicable township: <br /> 603 —E-MAILADORESS E-MA LADDRESSO <br /> �OUkj •''� , Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ��� Elevation of ro <br /> PARENT PARCEL 850 ZONING: ACREAGE P PeKY <br /> 0 Pte` �� V'R'� 7 I ... , 3 5 fro tage drawn to scale. <br /> G(s NUMBER <br /> TOWNSHIP: ` SECTION: <br /> D���rk 2(� %: fJ Yoh: S4 riveway permits <br /> I �� r aSan ,county,town) <br /> ADDRRESS: (Cluff (� �/t n / X X/` l` l rn e •CSM LOT SUBDIVISION BLOCK/LOT <br /> ��i I hen( pp,rp� <br /> (publi Private) <br /> PROPOSED PROJECT INFORMATION r= <br /> PROJECT DESCRIPTION: <br /> iJELJ i4Diui> <br /> RCThis project is a new building or structure. �, ,, <br /> r <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMB / r f V /� <br /> ❑sEWER ,SEPTIC {1/W`r/�/,'`\/1��(/��U) . � (!i e <br /> HEIGHT IN FEET. f r NUMBER OF STORIES: (Not including basement) t <br /> L <br /> 9 1 E a to.ate eq kir TO ST SQUARE FOOT <br /> (Outside dimensions inducing unfinished area,attached garages and above grade decks or es) a <br /> 9 �' � '�P 1-:::::'711=7t72-';',,,-2%.1,,' <br /> BASEMENT: ` + �/ c ,sTROOFt <br /> 1\Ito lq\ �� j TOTAL SQUARE FOOTAGE: ,, : - L4.. <br /> 2ND FLOOR: 3RD FLOOR �j <br /> Vsv i T Kg <br /> ESTIMATED CONSTRUCTION COST: - <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? oyes No )(Don't know <br /> 2. is there a wetland or floodplain on or near the property? <br /> Dyes It45 No 1 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in th e past 5 years? ❑Yes 'No <br /> 5. Is this project associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) (J yes a <br /> ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes �'No <br /> 41 <br /> APPLICATION MUST BE SIGNED <br /> 545-112( ) (Continue on Back) -► -► -► <br /> 1462_, ( % -1) 'litte (j\lt1 <br /> , - rj - .'f- n-e4,0 .6Z <br /> i 0{1 <br />