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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTO ' 0 PROVIDE <br /> OWNER NAME J,� h <br /> 13'remd-Am o( <br /> Ma.(I'.y L Zo' ng Status;CUP; <br /> OWNER ADDRESS ( mber,Street,City�State,Zip) .eed Restriction;CSM <br /> aP N(c off -Or 1 �U Wk 53932 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> `20-3S0'241,5 *-- bfonc Y izaa•cl0 Q -tvtsx;.%•Gov," Bite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mc ke_ ++aa rl f 0.I [ Site Plan including location <br /> AGEN DDRESS CONTRACTOR DRESS of well/septic <br /> cky Nlc�rw f 1 Q$ �Jlc ia£f �r <br /> (Ci State,Zp �tbaClCS <br /> v9,State,Zip <br /> 91t 'P-�Nt l Lit 3 K.�vc r wl Z � <br /> PHONE ' PH ` 53�3 I_J Site Plan approval from <br /> q2o-30_ 7.6246 PHONE 350— (OS applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r,G,n,di:LA- , 'v Q. yugul. , , 0 cGvtcka, ,std.'"0 e - L(Q Lc.,,13<loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.us/) evation of <br /> PARENT PARCEL NUMBER: CO RENT ACREAGE: property <br /> ❑PARCEL 07(x_ 12Y- 0”12-0 K-( "7�Q f 01 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: 5 vo -f-r-Alec- '/: 56 '/a'/: r Driveway permits <br /> (DRESS: tate,county,town) <br /> Sg-I o �e -� L. Sanitary permits <br /> CSM: LOT 1 I UBarto Noll BLOCK/LOT 4 (publi Arai 4 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: N/� , MI .1 r ' e' i ��,1 <br /> 'v OA) �� '► V V J �1#1A oning District <br /> project is a new building or structure. Q 'permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ •:I Address <br /> EWER EPTIC ri-2014 - ooaa 3 G/existing) <br /> vorEIGHT IN FEET: YY�� NUMBER OF STORIES: (Not including basement) <br /> 0191 ' Ga ❑ Wetla • I•••plain/ <br /> Shorela •' "-ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 1ST FLOOR:RI_^ ^ ❑ Erosio ntrol permit <br /> I U \//� + TOTAL SQUARE FOOTAGE: 4 (slopes, • - o rbance, <br /> filling/:..«: <br /> 2ND FLOOR: LA 19 3RD FLOOR: r ' <br /> 1/IJ C-I -f- eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q� and available optiogs. <br /> (Please round to nearest dollar) $ o�5� 1 \NO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes o Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ci3No <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 ►j o ['Don't know <br /> 7. Is this to correct a violation? ['Yes I o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ <br /> 545-112(4/08) <br />