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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 11// rr <br /> VA'^ 'T- C\�-\-5 >r €5- °( r t, ck-°Z ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME r <br /> ��v�.eA-pc ��l-5.a-Uc(6r\ Z---1--C ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) , El <br /> Ne_.-) CoL.c.is , w1 ,535-7`{ <br /> PHONE PHONE ❑Site Plan approval from <br /> (00(8,- -5-lb - -7‘ (g applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> -t, _ qA b \<c■l, 4 ,I `Ac-j- ❑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 /> ❑PARCEL p (� pp�� l frontage drawn to scale. <br /> NUMBER o7©g3o-58D$V4 R-es,..-e.\ <br /> TOWNSHIP: SECTION: <br /> 1�4. 1�4%. ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> 35;Ct. -1—‘ - LEZ., .e � 5 ' 1(o«(,�-5 /U3\ . 3-39- 8- <br /> ? ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 11 el f Ye, ❑ Zoning 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: ❑ Rural Address <br /> FIEVVER PZPEPTIC <br /> (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I w e 5t e vi o ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ rosionContr01 permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: 4. (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> .5;G N t F' ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --01. -2 ♦ • (96 000 <br /> and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ElNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes No ['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? ❑Yes 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 EgNo ['Don't know <br /> 7. Is this to correct a violation? [Yes ow <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/08) <br />