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____S_SI?) <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �_- <br /> J 5 J R,g,r S .. Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> /Uc�,,(' �-10 (' S�u � .rn� �;,;1 535-23- Variance(# ) <br /> HO P ONE CELL PHONE E-MAIL ADDRES <br /> 'C ?) y w Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION .nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) 1etbacks <br /> PHONE PHONE ❑ Site an approval from <br /> licable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> R Floo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn evati► o •ro e <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: "�� P rty <br /> 0 PARCEL Ito -tea _9000-3 g<_. `/ s3.c'y fron .ge •rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> u In in -)_G 14: 1\11J wA: SW F' Drive ypermits <br /> ADDRESS: �] r (st ,county,town) <br /> 57AC UC/r'"A 1N' c4✓ ¶ -)VCj( . o,-) Lit- 5-3cSi? Sanita rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu ,private) <br /> PROPOSED PROJECT INFORMATION f ' <br /> 4 <br /> PROJECT DESCRIPTION: / \n, �_„,,-. - ,e . t � ,� r,--7"`„',;.' '!"°-., ,-.. ''''.""'"' '',"p,,.:..TA <br /> This project is a new building or structure. , a <br /> CI This project is an addition/alteration to an existing building or structure. 4 k 44 <br /> SANITARY SERVICE: PERMIT NUMBER: � aP��t ,! ,? �� <br /> ; EI a�• <br /> SEWER ❑SEPTIC ; , - .. <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) Sf v.,' '-. ',? � <br /> T� 1 •K 1 7 <br /> AREA TO NEAREST SQUARE FOOT: 4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1 : <br /> BASEMENT: 1ST FLOOR $ <br /> 4„,,,' <br /> C� TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLO 4 � <br /> .a A, , z ,rr <br /> ESTIMATED CONSTRUCTION COST: -,3_ A 4 d �,••, ' <br /> (Please round to nearest dollar) -4. "∎ - -'► -+ $ .. . _- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Of ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes f No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? BYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes 2i No's <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) DYes 4 No Don't know <br /> 7. Is this to correct a violation? ❑Yes XNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />