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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME —�--2-(y '} <br /> i�-elAl I ).-(- c ❑Zoning Status;CUP; <br /> 0 ER ADDRESS (Number,Street,City,State,Zip) <br /> 9 5 6 11- ( - 5T 0 EE-r 2-706 Ai 1 3 Deed Restriction;CSM <br /> HOME PHONE CELL P •, E-MAIL ADDRESS '""�rT Variance(# ) <br /> -'3W0 boy ' <br /> •.yr I.• �Imo: .. , 2 t4( .6-4-1S J SCOI3C4 N.0d11 ['Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM /t CONTRACTOR NAM <br /> 1k - <j zk J- ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,Slate,Zip) (City,State,Zip) El Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl7 ❑Elevation of property <br /> PARENT PARCF.�IUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL ' frontage drawn to scale. <br /> NUMBER 07 Z "-25y 2.S gel"c g"3 • 71P <br /> TOWNSHIP: A � SECTION: <br /> t.` t ZJ k) 1e: 1/41/4: ❑Driveway permits <br /> ADDR SS: (state,county,town) <br /> 1 S C "v ' '`k 5/- ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 9- 10-is (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REViIEW <br /> PROJECT DESCRIPTION: <br /> t Z x ZO DU-'1 .' ❑ Zoning District <br /> his project is a new building or structure. U Petmltted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address - <br /> (WER [EPTIC �� (near/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> U Wetland/Floodplalnl <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: D 1=rOSloriContr07ermft <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filiirtglaccess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2'4101, Z q0 1;1 RevlewLocationSurvey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ --► ♦ ♦ QQ�� o and available options <br /> (Please round to nearest dollar) $ /6, epp , r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [ Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ti es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <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 V, o ❑Don't know <br /> 7. Is this to correct a violation? Dies Ell'r o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) (Continue on Back) —► ♦ —► <br />