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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU ' OMER TO PROVIDE <br /> owN I/.2" . \-.^:-) L ( o <br /> ``- 7, Zoqing Status;CUP; <br /> OWNER ADDRSS (Num er,Street,City,State, ip) p D Restriction; CSM <br /> ql�6 fiver" CJbSf Na c�'t ► �i 5.. 2? Vfrriance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDR SS > <br /> bag— 18 --06) icE--y?Z t 3 ad�:lc6-I4 r6J 4- rs .W:t<cc <br /> die Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION `nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Ite Plan proval from <br /> p lic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ['l 4or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL�UMBER: CURRENT NING:/ ACREAGE: }levation of property <br /> El PARCEL o?> �7°7 xi-s�I°_S -NUMBER .1 3 <br /> frontage draw scale. <br /> TOWNSHIP: SECTION <br /> 7o„�u .0f. C'� f �(a h S '/4: t.� � 'h%: ❑ Drivewa ermits <br /> ADDRESS: �.�P �f'-` (state ounty,t n) <br /> -7q&6 vt l tu.44-cry ) I C'tt0Cs 14a h t S U., ( � �� C-2-.J ❑Sanitary rmits <br /> csM:0 Z 5-Z4_ LOT SUBDIVISIDN BLOCK/LOT (• blic rivate) <br /> PROPOSED PROJECT INFORMATION .; <br /> PROJECT DESCRIPTION: II �t J'rrw - �Jga t <br /> u 1° -+% I ,-.4Yes f'r-ct'1Zo ( ctNoe_ io4i� 7. i'in DIstr� <br /> . [` This project is a new buildin r structure. GIs <br /> ❑This project is an addition/ teration to an existing building or structure. <br /> SANITARY SERVICE: ' PERMIT NUMBER: L�p ? • c�'' ' ' <br /> EWER VEPTIC (new/ S lti9 ,y <br /> HEIGHT IN FEET: ic2A...... NUMBER OF STORIES: (Not in ding basement) <br /> Q Wetlart• .. . .,! ;, <br /> AREA TO NEAREST SQUARE FOOT: SF(CIle x ✓ � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a ". 4� <br /> Et'QW../ 4t1 •( I( <br /> BASEMENT: 1ST FLOOR: � � �ow.,'Z $ lJ g c�% j TOTAL SQUARE FOOTAGE: + c P slopes, • , Ce, <br /> �� � )IIInga« s I <br /> 2ND FLOOR: 3RD FLOOR: <br /> `t(v SZ p-a ,dReviewLocationSurvey jr i �� <br /> ESTIMATED CONSTRUCTION COST: ♦ -�► -► ♦ ♦ ♦ atltl avail ble flptlQn s V <br /> (Please round to nearest dollar) foo�"-rra�>�tv�c. I�o � <br /> CoArrel e eorS of I,Ooo <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? Dyes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? IYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ` ['Yes plo <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 glo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ —► <br /> 545-112(4108) i <br />