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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 /> 1(c-,--e ercI4 y "r-,cS5;c`, /- hL� ❑Zoning Status; CUP; <br /> OWNER ADDRESS ( umber,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> E)11 3 CoL y ( , ( 11, P re ,c,1 , 53 S7�- Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (wog—57C-303 I/ n rave 006 5 rvns, f,,af',-' ©Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> in Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL UMBER: CURRENT ONING: ACREAGE: <br /> ❑PARCEL D`/SIos07-�1-c°�Syb-k. pi-I CURRENT 3 frontage drawn to scale. <br /> NUMBER ` <br /> TOWNSHIP: SECTION: <br /> Io_. c c)- - Pc:-0-.rose. 1/4: 1/1/.: ❑Driveway permits <br /> ADDRESS: II 1_ (- (state,county,town) <br /> C/oy3 Co[L i[ / yv1 T I 1°,e (") 15-1c72_ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> pj I(o I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Aolof p d e,-k --v e>c:s/.'„,,5 ho t-N-5 e- ❑ Zoning District <br /> ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> J ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ,--1 Erosion Control permit <br /> 01(91/ 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -■ -► -► -► ♦ ♦ $ o� and available options. <br /> (Please round to nearest dollar) $ 7/(/��, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives Ilo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeslo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EN. <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) Lives E o ❑Don't know <br /> 7. Is this to correct a violation? ['Yes 171No <br /> I <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br /> I <br />