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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 /> ►een�sea{S✓')tSS O Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> J Z- iiva/ 'i led midma.n'4 /- f/ 5 3s� Deed Variance Restriction;CSM <br /> W Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6-Z"5--Uck3 — freed leave ' nncc/-Am? EISTte Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and i eludes dimensions <br /> AGENT NAME CONTT CTOR NAME B' /�- /' 1 <br /> d0/1dJ L/ ec/CJiC'r h` Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> TrZ .1/1244C /01 ?(' <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE NNE 20` 111 e 6. -r7r6 ite Plan approval from <br /> 6 or- ?9,r= V6 2,,s' applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,s.1�� r-9 73 f, 4 , t, .ow., loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.w1,us/) <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> El Nu BER 031//0 8G(Q —01-4-9,61-o A-9- ey_ 3(,, , I�-}i� fronta drawn to scale. <br /> TOWNSHIP: SECTION: <br /> a z Q/JX n t{ 3 1/4. S 1/A: riveway permits 4 <br /> ADDRESS: '�!/ �`/ (state,county,tow ) <br /> /693Z, MK /2? - /Au)man i-c t0 I 5 3S/6 4 Sanitary permits A(4 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT CRIPTION: ) I <br /> rectal d d} - o ❑ Zoning.District <br /> . ❑This project is a new building or structure. ? <br /> ❑ Permitted Use? <br /> . <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU e ❑ Rural Address <br /> FIEWER ZEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER STORIES: (Not including basement) <br /> a-v ' / ❑ Wettand/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoretand (attachment) <br /> (Outside dimensions-including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1 ST FLOG <br /> ❑ ErosionControl permit <br /> /'� ,['6 © /� 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> G' filling/access) <br /> 2ND FLOOR: 3RD FLOOR:I A <br /> V ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ , /�I��� and available options. <br /> (Please round to nearest dollar) (..H- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? aes ,No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? fees 'lo <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) Efres .lo ODon't know <br /> 7. Is this to correct a violation? [Yes 1lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -► -+ <br />