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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME A <br /> FRET 4 Meat"A 6N0(1NIS ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 815-11$-3I// i»cJENKtN,$ Z( lto ( • I ,,,,t El Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> _ V5-1-it.) Si-k''' r71 ,,S:NM1 Tr 61J,,u.'a4-4 &/6A? r✓c. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 314 N), A-rwv-e 1-k1, <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 2FieLO I kys, 5353 <br /> PHONE PHONE ❑Site Plan approval from <br /> (poi-ZiS-3 27,E applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Si:.yy,.t,TT 31.-Des'a Mile,, c:rrti ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: p CURRENT g211:: ACREAGE' <br /> El NUMBER C'S1 f 12 Li.3g7(/ • ?-7� frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> Sir,) f tA)QIC S '/.: SE 1/41/<: s 12 El Driveway permits <br /> ADDRESS: � (state,county,town) <br /> -®6 [ — ?-o -eC 7- L ❑Sanitary permits <br /> CSM: LOT 5.7 P SUBDIVISION BLOCK/LOT <br /> •7 O Oytaj WOoflf (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> w l•tomC ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> {)EWER SEPTIC 13- ion - 000 to (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 23 I LI Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I-1 EroslonControl permit <br /> 17 Ir+ D 1 2) Q 7 7 ,$ TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> Lii 4 y L LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -0. -0. -0. -0. $ 32A, oOD, p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes O'° ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ElYes go JDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1lo <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 OVo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />