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SUPPLEMENT toWeb App#'. <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY•,OWNER:INFORMATION CUSTOMER TO PROVIDE <br /> OWNER ME <br /> ` I`" D t P11*-f .(e_4' ( .i - t S Zoning S <br /> OWNER ADDRESS (Number,Street,City,State,Zip) g tatus' CUP' <br /> 6-ZA at-. 1ZP. . t S� i l.�f S31 t8 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • Li0i3 5 4` SDaY ''re-l-VteiL� LZ 6(-u- Site Plan drawn to scale <br /> AGENT INFORMATION,-: ` 'CONTRACTOR.INFORMATION M,t ;', and includes dimensions <br /> AGENT NAME I/ CONTRACTOR NAME <br /> N J O Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) O Setbacks <br /> PHONE PHONE O Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> O Floor plans to scale <br /> 'PROPERTY/LOCATION—INFORMATION • (tittpo//accessdane ce`da ne wiiise ,,'M <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: O Elevation of property <br /> . OPARCEL frontage drawn to scale. <br /> NUMBER �l O li-LP I f}F�ISD <br /> TOWNSHIP: SECTION: <br /> . C-61/41•1 D . 12,U r—ii- Y4: V4Y4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> O Sanitary permits <br /> CSM: , LOT SUBDIVISION BLOCK/LOT <br /> 0 3 v (public,private) <br /> PROPOSED PROJECT INFORMATION , -= - ,STAFF W REVIE <br /> PROJECT DESCRIPTION: =Y t <br /> 'IT:,ol-- 'Ro C.%R A-145.DI-rLc J c n/ z._-0-v..._44.--- =O Zoning Dtstnct r <br /> ❑This project is a new building or structure. ° '� r 4 t- s� <br /> Pefmitted l e? s <br /> VThis project is an addition/alteration to an existing building or structure. 1, � . f <br /> SANITARY SERVICE: PERMIT NUMBER: 11 :RUral Address ti <br /> S. <br /> EWER rPEPTIC (new/extstmg) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) f.. <br /> 1 <br /> i 2 - :0 Wetland/F000dplain/ _ <br /> Shoreland(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ® 4..:.- ? � <br /> BASEMENT 1ST FLO R: - <br /> �rosionControl pErmit'� <br /> (� l TOTAL SQUARE FOOTAGE 4, slopes disturbance <br /> s:fillUrkalp ess) <br /> 2ND FLOOR: 3RD FLOOR: 1 <br /> �t+ <br /> e .'ca, v,r r fl'RviewL at Suey <br /> , '- a.a` ,y q{j.,,yt ESTIMATED CONSTRUCTION COST: an,d avaabl options(Please round to nearest dollar) ♦ ♦ --∎ -* ♦ ♦ f Tr3 ) <br /> 54f' r ` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? aes E io ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Wes ONo <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) QYes Elo Don't know <br /> 7. Is this to correct a violation? QYes IT& o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -t. <br /> 545-112(4/08) <br />