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• <br /> SUP.PLEMENT to;liYeb App <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> p ROPERTY O_WNER_INFORMATIONy . : Y.,,_., . § "..; CU-TOMER TO PROVIDE <br /> OWNER NAME J <br /> U A- C K- M AK K-( A II Zo ng Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zp) D d Restriction;CSM <br /> ( ( `� 1 'Av/4/vNlt' mou/V Y • 6IC - CJ t 3-----2,s- -7 V r' nce(# ) <br /> HOME PHONE CELL PHONE E AIL ADDRESS . - • <br /> Oi 7- I - Si •DS Got c_55 /, ,0 'tic ac 4' , I , a Sit Plan drawn to scale <br /> AGENTt1NFORMATION, ii: CONTRAC 01C1NF.ORMAT,ION_'mo t " .Vd ipicludes dimensions <br /> 'AGENT NAME CONTRACTOR NAME _ ..., _ `/ <br /> . O Site/Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS r of 1pVell/septic <br /> (City,State,Zp) (City,State,Zp) O Setbacks <br /> PHONE PHONE O S' Plan appr•-al m <br /> - pplicab rs• ip. <br /> E-MAIL ADDRESS E-MAILADDRESS • <br /> Floor ns to s <br /> :PROPERTY/LOCATION T0IQ,C0. (http//ac_cessdane co d_ane wk us/j 'y"4z <br /> PARENT PARCELN MBER: BURR TZONING: ACREAGE Elevatio fprope <br /> PARCEL `' frontag draw scale. <br /> NUMBER © " o �` - � (c/� �V <br /> TOWNSHIP: SECT <br /> yd %40 yiy: ❑Drivew permits <br /> ADDRESS: Q617 <br /> J (stat county, - n) <br /> 1 I \ �` ) 0 C O nita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT . C,private) <br /> PROPOSED PROJECT INFORMATION r` � -- ;;i STAFF REVIEW ' r: <br /> PROJECT DESCRIPTION: "' <br /> � .;I y\1 i E hx : <br /> d l?( a ((a l Zong Dsct <br /> t <br /> This project is a new building or structure. a rte .�; <br /> P j g 'Lia Peefiii fo• dse? Ott M� <br /> This project is an additio alteration to an.existing building or structure. q-'"A M '�3 ' -;21?-:%%C1-0;71 <br /> SANITARY SERVICE PERMIT NUMBER '� Rural •dres ; rg Y - <br /> EEWER EPTIC =.- CneW7 Ali:fig� `r <br /> ;mow err M s /i„ <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) - yar ,.,. t <br /> 5 vetlar�,d/Flo• • alvi/ -, <br /> �- Shorela Aa�ttechme <br /> AREA TO NEAREST SQUARE FOOT , x -- a , ;_ x1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '"" % .- •sr�r-`"g <br /> 0 EroslonContrc • It <br /> BASEMENT: 1ST FLOOR 41 O i3'I` r�aM ' ,+: <br /> 4,TOTAL SQUARE FOOTAGE: ,j, .({;jO .q.§-,-,.q1 <br /> • <br /> 2ND FLOOR 3RD FLOOR"� f 4��9 a SS . J . <br /> "T e <br /> k vieW ll;00tlop—2,..",-,,. t_-74S7;1.n y <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -11. —I- -+ ' v tziA ar d a allaoplo <br /> (Please round to nearest dollar) 1 - xs r =w f Vimi-, <br /> . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes [ lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes lri o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Frgi -s E o <br /> 4.. Has there been a zoning permit issued for this property in the past 5 years? - 11 es to <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if•e-e) . <br /> 6. Is a location survey required? (see reverse) QYes ja' o ODon't know <br /> 7. Is this to correct a violation?- [Yes II''-o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -♦ —► <br /> 545-112(4109) . <br />