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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAM / <br /> r' Z k6 NX �- Zoning Status; CUP; <br /> OWNER DDRESS (Number,Street,City,State,Zip) <br /> lO t i' Tease-- i� Via � Id I, s, 573 eed Restriction; CSM <br /> V ariance(# ) <br /> HOME PHONE CELL PHONE <br /> E-MAIL ADDRESS <br /> SOY-y9y 1,23/ 698-q € 0 eaab o-F- <br /> F g>al?,'c_o M Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan a oval from <br /> applica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> !) Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: J CURRENTZON G: ACREAGE: IA Elevation of property <br /> ❑NUM ® <br /> BER , CC, q ,S 1 coKi -3 - I �{, • frontage drawn to scat <br /> TOWNSHIP: I SECT ON- <br /> ' r= '/a'/a: 31--_-_.. ❑Drivewa rmits <br /> I .1/4: IQ oun town <br /> ADDRESS: ( �' <br /> OR I © S 11 �5 _ ❑Sanitary ■- its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> •1)\ •Ubll I rivate) <br /> PROPOSED PROJECT INFORMATION of STAFF REVIEW <br /> PROJECT ESCRIPTION: �f <br /> �o, dert J14'i�i4 �/-ie�/ r xo2o <br /> kg" Zoning District <br /> This project is a new building or structure. <br /> • ® P 1 9 r Permitted e. <br /> ❑This project is an addition/alteration to an existing building or stru ture. <br /> SANITARY SERVICE: PERMIT NUMBER: , ❑ Rural 'ddre <br /> N q- FFEWER pEPTIC J (new/- fisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> , '/ ❑ Wetland/FI ain/ <br /> ip <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionControl rmit <br /> BASEMENT: 1ST FLOOR: <br /> 0/k (9-01 j TOTAL SQUARE FOOTAGE: j (slopes,dis ante, <br /> 2ND FLOOR: 3RD FLOOR: filling/a Ss)ogovsF <br /> ❑ Revi w Location Survey 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ -i ♦ 2/O ©© and available options. <br /> (Please round to nearest dollar) 3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ENo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Tres L'Jo <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 ao ❑Don't know <br /> 7. Is this to correct a violation? [Yes eao <br /> "4 CD Ce' APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545112(4/08) , <br />