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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> owNE .vsrNeSS H. -c ec ( • 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Nu Stree ip1 �`1� Deed Restriction; CSM <br /> l 6110 Cr �� V`tp1 � �S Variance(# ) <br /> HOME PHONE CELL PHONE E- AILiNDDRESS� , a`{ <br /> 6? S., ■ :4_11�_ 44- '74 F VS►/1-CSS 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 9 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 ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: j� �/�- CURRENT ONING: ACREAGE: frontage drawn to scale. <br /> El PARCEL NUMBER r/ r G���[b T CJ ! <br /> TO HIP: sECTIO Driveway permits <br /> X 6u- - 1/4: 1/114: (state,county,town) <br /> AD RE k <br /> '- <br /> '42z+ Lril ,y ID Sanitary permits 3 CSM: LOT :DI SI BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D CRIPTION:0 <br /> c ly V-C9cL4 kS9 Li 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 /> V EWER EPTIC <br /> / > �`- -©O/6 (new/existing) <br /> ,7 <br /> HEIGHT IN FEET .t <br /> t CI OF STORIES: (Not including basement) <br /> 6 Wetland/Floodplain/ <br /> 6 Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT: 7,5-6, 1ST FLOOR: AO 0 4 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: / �/ <br /> -- `1 y ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 7 q O 0. and available options. <br /> • <br /> (Please round to nearest dollar) � — (�L <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes LJI1 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QY s L=JNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? INI1'es QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ENO <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) °eye blank if none) <br /> 6. Is a location survey required? (see reverse) ales �[;; • QDon't know <br /> 7. Is this to correct a violation? QYes I. <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. -4 <br /> 545-112(4/08) <br />