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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS NAME <br /> �l.._ I 1"0 M PS0 IQ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number.Street.City,State,Zip) Deed Restriction; CSM <br /> 77ZV G ��v Ai c.)0 P vc—�U4.iA Variance(# ) <br /> HOME PHONE ELL PHONE E-MAIL, 6-714°ADDRESS <br /> 6o8)g241-9614‘ D AL two ' CM7At46, iver ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /l,/tX' SO sg7 C�tA-zy 43u it-01 '1)6--coo ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> S•em c T gOX 9 30 Zzv <br /> (City,State,Zip) (City,State.Zip) El Setbacks <br /> J 2o 'vim w l s3S93 <br /> PHONE PHONE El Site Plan approval from <br /> 600- K y c—970C) <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> AiS ptip g c cc,e ay 6ti/cot 6.r El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR E. <br /> ❑Elevation of property <br /> ❑PARCEL oDe 31/z 7-13 c J�_l frontage drawn to scale. <br /> NUMBER / I <br /> TOWNSHIP: SECTION: <br /> 7V4se,✓ /97/0/21 -7Df✓ IA: '/1/a. ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 7-7 Z(-7 Gr Z4, a0 i2 p u&Wee, ivN- , (v/ 53.0 3 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: fin!/6 / 'o.4C/i <br /> Z VX z1O )(// Grtefer-/Sic?,Teo ❑ Zoning District <br /> . RiThis 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 /> EWER <br /> 1-4PTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /S ' y"Pelf 14- / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: r—, <br /> ErosionControl permit <br /> 960 7*-Z yO + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> C filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 12 d v <br /> ( Z dr>Ce ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> ♦ <br /> (Please round to nearest dollar) Z 5¢:, a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes BNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ISfres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes JAIo <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) Dies UNo ❑Don't know <br /> 7. Is this to correct a violation? [Yes J;'k o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />