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SUPPLEMENT to Web-App # <br /> ' ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE . cec <br /> . - OWNER NAME /� <br /> 0 e C o;rv1 e f¢ct k�� Lx, ew �r gZoning Status;CUP; A <br /> OWNER AD$RESS (Number,Street,City,State,Zip) p r Deed Restriction;CSM <br /> J 5(0 C..o �w 8 0 e QrC7 1'`° /c" 0.15-f-iv Variance(# ) <br /> HOME PHONE CELL PHON E-MAIL ADDRESS <br /> (Gbe-'741-%35 XfSite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AT NAME CONTRACTOR NAME <br /> Jp n 1 111 p11G ny o)e--ccluT-1 e1,- 64;)o' dS• - '' r .uding location <br /> AGENT ADDRESS p CONTRACTOR ADDRESS '.�;Tl'- "9 C <br /> 13 5 / Q�,v(J t .'/' <br /> (City State,Zip) (City,State,Zip) <br /> A Setbacks <br /> 0-eQ i � to I W 55-3/ <br /> PHONE PHONE V Site Plan approval from <br /> (0046— 7Gy - cols (op<( - (vq - `7 ?ZS applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> X Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ <br /> NUMBER 02.y-0,a-ill-1,w-1 l4-/ems frontage drawn to scale. <br /> TOWNSHIP: ^ �� SECTION: <br /> Q Al e r ; ,..„ 1/4: IV) %IA: 1U +t,) Drivew- its• <br /> ADDRESS: (stat- oun, ,town) <br /> isscp to, Iry (3 b 9(Sanitary p- <br /> CSM: WT SUBDIVISION BLOCK/LOT (public iligi <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D SCRIPTION: t p <br /> r\e 1/,-,p ti e o (ci P r-c L,, � /ate Lo ti-IL, 24,'/v' Xzog District (,jJ..., c.,„,.. <br /> . ❑This project is a new building or structure. ( l Permitted Use*,/ I j <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 64 RUTS) ' •'• 51-K. <br /> J SEWER ❑SEPTIC (new/t' /� /1 I <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) /„ !")D/1 <br /> rill r,. . ..,.; nt <br /> AREA TO NEAREST SQUARE FOOT: t(Outside dimensions including unfinished area,attached garages and above grade decks or porches) I BASEMENT: 1ST FLOOR: E �1'�'cl � t <br /> TOTAL SQUARE FOOTAGE: j (. •e=, a ' , C8, <br /> ...t-a..,>`, S pq.c e 3(4 fill' ':M, A}1 ` t. <br /> 2ND FLOOR: 3RD FLOOR: J 3@0 <br /> 3 GV, 00 keReview Location Survey / A__ <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) $ Z 5COd , t9 O /// YYY <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El-No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Cl'No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Etflo <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 C 10 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes L FicJ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -P -P <br /> 545-112(4/08) <br /> ,)1 O <br />