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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> &C.I21 -L,el IDI Ass D (AD <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (NunVer,Street,City,State,Zip) / 2 / Deed Restriction; CSM <br /> ft p /u/R fA L-/AU t `�GtC't=i�' +o s ID( S363 T Variance(# ) <br /> HOME PHONE CELL PHONE f E-MAIL ADDRESS <br /> 7/6- 9e6.-9,028 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE NAME CONTRACTOR NAME em <br /> 44,ue i--,41,--16 1( 14/ 4 e-/( (.SLS ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 38/8 1zcas <br /> (City,State,Zip) (City,State,Zip) e ❑Setbacks <br /> MC90 is15tit t s"3`?/8 <br /> PHONE PHONE ❑Site Plan approval from <br /> ('C'S —22.Z- 17 36 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ciii Awe t fj ,(f,00Ls , Co wr ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El NUMBER CQZ'0S'i2-o645-61-v R-/ O. ii'8 frontage drawn to scale. <br /> TOWNSHIP:: 4 SECTION: <br /> G I �3 1 D/0 6- .1/4. 1/41/4. ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> CSM: LOT 7 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> s <br /> BLu v 4v�,) 5,04 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /5/K 3a ( Jyc xcQ LVH p DV 0 Zoning District <br /> . EThis project is a new building or structure. Li Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> FIEWER ZEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0 Wetland/F000dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 0 ErosionControl permit <br /> y TOTAL SQUARE FOOTAGE: ,$ (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: �y <br /> 51! f <br /> 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: �-.,� e,C7 and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ mil° /o oc'r — <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ®Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives LNo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Lives I2No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ❑No dew i-l'{4-)Be'`) <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 LNo ['Don't know <br /> 7. Is this to correct a violation? Elves EiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -i <br /> 545-112(4/08) <br />