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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION FACE USE ONLY ,` <br /> OWN R AME .� <br /> a r�{1-Cv- ck Yct �'" onmg E2lstnct <br /> OWNS DDRESS (Nu b r S t,City, tare,Zip) <br /> 2 �(S i r W.:1 S3S34 ' <br /> Permitted.11se? <br /> PHONE �, / E-I AILA DRESS j� <br /> / C8`6`4" ML i i P4�A r C NF a5./„ -1- ❑Zonis+ 4,� us,CtJP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> AGENT NAME CONTRACTOR NAME 9 $Sfi�eti¢n,�!W:Sao <br /> �1'� .n variance(# _) <br /> N/14, S/i /l S O�tirv� <br /> AGENT ADDRESS CONTRACTOR ADDRESS Plan drawn t¢scale <br /> nd includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> PHONE PHONE Si : Plan including location <br /> o well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ ,le Pia .• am <br /> PARENT PARCEL NUM/BE : j'jI� ZONING: f E.X ACREAGE: obis toWn$il{ <br /> ❑ NUMBER j21 �`�si2 �l `� /\ 3J p <br /> TOWNS IP: SEy N: N "'! <br /> 7 1ii14++`1/ <br /> AD RESS: <br /> v4 1 5t 1' . ` �: n; w--,_ S 53 <br /> 3 lour plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECj.DE�SC}�� <br /> ////--�IKK�,jj���I���,,JJlI++ ❑ Drivewa ',S"'~'• .�`�� <br /> ❑This project is a new building or structure. .county,town) <br /> • This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: f f�I p- Sanitary permits <br /> ❑SEWER %SEPTIC Z� ((�11p �' (public,private) <br /> HEIGHT IN FEET: 1 NUMBER OF STORIES: (Not including basement) ❑ Vlletland/Fl plaint 1,8 �• S r (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �r¢StonCQntroI permit <br /> BASEMENT: 1ST FLOOR: (slOpeS,diSfUrbanCe, <br /> 4, <br /> TOTAL SQUARE FOOTAGE: <br /> titiingtaccess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Locat' rvey <br /> ESTIMATED CONSTRUCTION COST: _, ..+ _♦ — ♦ ♦ $ -r5t ®00 ��— �an< ►e options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? Li Yes 'IA No ❑Don't know <br /> 3. Have you talked with the township about your project? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1 N <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blan none) <br /> 6. Is a location survey required? ❑Yes No Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -► <br /> 545-112(1108) <br />