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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 /> LTAIVIA 6 0-11L ier T� ®Zoning Status;CUP; <br /> OWNER ADD ES (Number,Street,Ci y,State, ip) �� t ' Deed Restriction; CSM <br /> --12A 1��� � �� �v X353 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> L it O2 283 TTDtop - 'Mtn inSU( flce .onv on' ®Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I( 1 fi1i? I)S ' SPett;(-VW RictikkAs IJS Tg-LLCTc cid ®Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> PbRVI8CO PSI i € -v <br /> (C�t��I� �I ����� (City,State,Zip) ❑Setbacks <br /> V L,L.&, 101 .5- 5-21.-1' <br /> PHONE PHONE ❑Site Plan approval from <br /> tO$. 152.-9S51 (OOb - 157 -/M-) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> wed RICFf,/45 con/,STI tkrion/.iveT 1/7FD 7 Ric/9/90t 0 ca✓STiQ ON. 4/E7 40 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 /> ❑PNAURMCBEEIR 0)Z 05rz-0�3-S�°( C-o 9 5 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> �L j f 0� tiu-w '/4: Sid '//a: ❑ Driveway permits <br /> ADDRESS S�C) (state,county,town) , <br /> 1+ 11-ar W1t_LD I.) ID A'1) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 1251 4 / - - (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> /J J 1-1-6-114_E et IJS T IZ r1c-7t t NJ <br /> . <br /> This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> [EWER [EPTIC 'b- W 11- -COD' 3 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ' <br /> I6 I <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 35'9 1ST FLOOR:J c1/�G� L <br /> 2 3 yV'2 .sG� 4, TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 0 3RD FLOOR: _ t 15-6 1 d r <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦!•♦ ♦ ♦ (Pi p�-- od <br /> (Please round to nearest dollar) $ 0 o©f U v O , <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [JYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres ®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) ❑Yes ®No ❑Don't know <br /> 7. Is this to correct a violation? [Yes RINo 0 <br /> y� / �� APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 1 v' (Continue on Back) -♦ <br />