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G 31 SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> RI G i4 ' e goto Ft=4?'(e 04 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> WIkI29 Cilk.STV J 12‘14014 o ,Wy- 53575- Variance(# ) <br /> HOME PHONE j CELL PHONE E-MAIL ADDRESS <br /> OS• •—' - Z I , ' ' 45-01'ZS t2-Ic40 u J t ..• . , fW 7 . . 'al Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 01 U. FIVI ON TF.l,OA N(7 f2ttts k =N f u'— OW 0 ite Plan including location <br /> AGENT ADD ESS CONTRACTOR ADDRESS of well/septic <br /> $ - 1 VDSotJ 51' <br /> (City,State,Zip) (City,State,Zip) 4iietbacks <br /> , W , K)16 Wj 5 00 <br /> PHONE PHONE ■' •ite P - -i,proval from <br /> (QOa•-1°)S' 4E4 0 -p. -• = ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Cog-6 PAR c Nrort TfC1,. 1061 lc U N I lrl6U NS WI) , .k '' Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://arressdane.co.dane.wi.us/) lig Elevation of property <br /> ❑ PARENT PARCEL NUMBER: � a' -='j ACREAGE: t <br /> NUMBER 034-0804-124.9 •: __ _._ AQQ(t•e" 9.7 rontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Ad to 20M 19N 16 N W 1/4: N e '/4'/4:5 3 T% ❑ Driveway permits 1n 4%-v>7 ADDRESS: stat- • • • , • <br /> • • n9 MA) R Sanit-- __ - <br /> cswia--360% LOT SUBDIVISION BLOCK/LOT (pub private <br /> PROPOSED PROJECT INFORMATION ,: <br /> PROJECT DESCRIPTION: I A,,' ,'• e 1I <br /> 10969 -� F�. N4,� L ' to 00 �. . •t t : W i+� ,,4 ,, .� 40 " i <br /> A Pfi, '£ <br /> . C This project is a new building or structure. , <, ,:4 <br /> ❑This project is an addition/alteration to an existing building or structure. r s <br /> SANITARY SERVICE: PERMIT NUMBER: ," 3r r <br /> ❑SEWER SEPTIC S t 8 nS I ( °' , A °" '1 f <br /> HEIGHT IN FEET: 1 NUMBER OF STORIES: (Not including basement) " OZI< &,, <br /> 3Z I 2 �'i ( <br /> 533 � S4 d�� , <br /> AREA TO NEAREST SQUARE FOOT: 4a sIAj��'g, <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a `' A "' <br /> BASEMENT: 1ST FLOOR: a <br /> '24-4) 4 110 4, TOTAL SQUARE FOOTAGE: % t, <br /> 2ND FLOOR: 3RD FLOOR: 60 <br /> �s`. `";, � as:Wit#� rk <br /> ESTIMATED CONSTRUCTION COST: d� � _� 6,� ��v° � .� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 3 s�boo ' liate <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes F No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IiiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1 .Yes ❑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/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 0-No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes WNo <br /> APPLIST BE SIGNED <br /> (Continue CATION on BacMUk) ♦ -► <br /> 545-112(4/08) <br />