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,J <br /> SUPPLEMENT to Web-App# <br /> ellt—D$ <br /> ZONING PERMIT APPLICATION www.countyofdane.com . <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 7/7( E L 0 Lf/-4/f Zoning Status;CUP; A OWNER ADDRES Number,S eet,City,State ip) �eed Restriction;CS / <br /> X-5 /O ,e c-E/t/u ' // 7/)/S L r/(1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS/ I' / / <br /> 3 Z 9 7 Site Plan drawn to scale ) 2�S <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions / <br /> AGENT NAME CONTRACTOR NAME / <br /> I Ird kn icy / j Log 4//y /)&S/ u s K5laecluding location <br /> AGENT ADDRESS y CONTRACTORADDRES QD I/ s <br /> 2 �? d d ! b L P 01/ /3 uJ �Cl� <br /> (city,State,Veo'p) / <br /> (City,State,Zip)U JA- vt/ / S7 SV Z ,�.t Setbacks 57/52-b 6 (C 2 <br /> ' AJ � y , 3 <br /> PHONE PHONE Site Plan p r al from <br /> g77-i9/6 73/ o e0 / applicabl vt f ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> - — ,Q v e Gi,I., E5'6.US g eh94, V' Floor plans to scale <br /> PROPERTY/LOCATION <br /> INFORMATION (http://accessda n e.co.dane.wi.us/) ' <br /> PARENT P•-CELNUMB CURRENT Z ING: / ACREAGE: ❑ v ton of property <br /> rty <br /> 0 PARCEL a�p © ' /71_..N MBER <br /> CO, 2,c frontage drawn to scale. <br /> TOWNSHIP: SECTI�ry ' ,/ p <br /> (f 0 . 4: w '/.'/: E An Driveway perm;- A A <br /> ADDRESS: (state,county, I ei <br /> CSM: LOT SUBDIVISION BLOCK/LOT XSanip- ••'s c t D 02-2 <br /> �A r (public, <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: / t `` , <br /> A.r IrkiL Li 1" 3 <br /> . 1gThis project is a new building or structure. k.' ; . � b„ <br /> ❑This project is an addition/alteration to an existing building or structure. . ,, , , .Q <br /> SANITARY SERVICE: PERMIT NU E ," e a1 <br /> ❑SEWER SEPTIC g 0 v..__A <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> �� ,1 ' a,.. Z <br /> AREA TO NEAREST SQUARE FOOT: c7 . �" <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , .i ki ,. ti <br /> BASEMENT: 1ST FLOOR :; ® Aft! , <br /> S 3� +, TOTAL SQUAREFOOTAGE: 1 ( „. a 2ND FLOOR: Z Z t 3RD FLOOR: l /e 7 g <br /> Y <br /> ESTIMATED CONSTRUCTION COST: �r� -� <br /> (Please round to nearest dollar) ' ' ♦ ♦ ♦ $ 600 L� 4 C �' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ArNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes XIslo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? MYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes gtlo <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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes RNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />