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9 ' ✓ <br /> 7c <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> • ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> c j - . - ) _ ■ �� �" 1 Variance(# ) <br /> HOME PHONE CELL PHONE ' E-MAIL ADDRESS <br /> 1 ) c• F 1 1 ci 1• -Y. ' '1 - c•' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i C'\ ❑Site Plan including location <br /> AGENT ADDRESS CONTACTOR ADDRESS of well/septic <br /> '42--AS-(> l�^, -4) ")', <br /> (City,State,Zip) (City,State,Zip) _ ❑Setbacks <br /> . \, ,j1•_, 7 <br /> . 1 s I ' 1 <br /> PHONE PHONE ❑Site Plan approval from <br /> (o \t L. _ \ 1 ; applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -- ❑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 /> ❑NUM ER 01-14-i 't I`t'�1�'� A" I ( 1 )PARCEL , , - frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1) E..�5 H, ! J r w-1 . '/e: %'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 11-t ` C"GL- ' ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> V A L'- 1Jtr -1 DZoning1 <br /> . OThis project is a new building or structure. � <br /> � I't��iftad Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 R �l Address <br /> DEWER JEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> —1 -- 0 Wetland/Flt in/ ' <br /> `Sh lend (a "„ent;« <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 Ert aion ntrol mn <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: + (�Pe5,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: IIIIhG/dC$SS) <br /> ESTIMATED CONSTRUCTION COST: $ L" 4 " 0 an .'« F 1 U[V t)I <br /> (Please round to nearest dollar) •♦ ♦ ♦ ♦ ♦ -► �P I�tt =- ens- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes M.►o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes + o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eyes tO No <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) Eyes %4s o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ' .1<j o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ --► <br />