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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER AME Lc <br /> Ear !� oning Status; CUP; <br /> OWNER ADD ESS (Nu r,Street,City,State,Zip) <br /> cv/ 2`� l J Ns ou DfL Sv�1 tRI� w 1 S-3S—/0 Deed Restriction; CSM <br /> l i Variance(# ) <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS <br /> 4°F-8aS-4932.- !E ^'`/4—ucueYA-14°° "'`"'(Site Plan drawn to scale <br /> AGENT INFORMATh N CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 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 AD ESS E- LADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION .Http://accessdane.co.dane.wi.us/) <br /> PARENT PARCELNUMBE-• CURRENTZONI G: ACREAGE: evationofproperty <br /> ❑NUMBER 09 f( 30 i! Q/a 4 -1 �i / ?_C" frontage drawn to scale. <br /> TOWNSHIP: SE TION: <br /> ' j S1-0L— 'A: 1/1/a: ❑Drive a rmits <br /> ADDRESS: <br /> (sta , unty,town) <br /> qt/ 9 !i ris n Or Sani permits n /� <br /> CSM: LOT Zel-4-isis)" lel,gl L-4° LO1� (pub'C, rivate) V cin <br /> PROPOSED PROJECT INFORMATION `1 J STAFF REVIEW <br /> PROJE T DESCRIPTION: / <br /> .-S $ 1Dle 6 5/!G P I a-D ,I 2 o District <br /> . ,This project is a new building or structure. 'Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> / SANITARY SERVICE: PERMIT NUMBER: Address <br /> I [EWER r)EPTIC neal w/ <br /> HEIGHT IN FEET: / �i NUMBER OF STORIES: (Not including basement) <br /> //" A R-. p/JG ❑ Wet! Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: S and (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ Erosio C trot permit <br /> c0 j TOTAL SQUARE FOOTAGE: 1 (slop , isturbance, <br /> 2ND FLOOR: 3RD FLOOR: / full lace SS) <br /> Z�f o <br /> eview L tion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ZS� , and av a le options. <br /> (Please round to nearest dollar) <br /> NAiii <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Flo Don't know <br /> ❑ , ['Don't 2. Is there a wetland or floodplain on or near the property? <br /> Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,ces o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes Yomo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) ❑Yes Vo ['Don't know <br /> 7. Is this to correct a violation? Efres pfo <br /> APPLICATION MUST BE SIGNED <br /> 545-112 laioa> (Continue on Back) —► —► -i <br />