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• <br /> • <br /> ' SUPPLEMENT to Web-App# <br /> • ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Ki ' & CGf p , ❑ 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 /> -2'12-7325 <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ✓ <br /> nn / V t-/" S ❑ Site Plan including location <br /> AGENT AD RESS L CONTRACTOR ADDRESS of well/septic <br /> 46- l_/°y. l3 <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> K50A!, AL. 3 /.. <br /> PHON (,6_3�29 PHONE ❑ Site Plan approval from <br /> 57"2`7 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> 1314;Sp.W <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING:(http://accessdane.co.daAnceR.EwAGLE71) <br /> of <br /> ❑ PARCEL C — 2. /_ j frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 8,-r�ce� 1/<: 1/<1/: ❑ Driveway permits <br /> ADDRESS: / (state,county,town) <br /> 41 2' 7J McCoy PO <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION # ="' <br /> PROJECT DESCRIPTION: , <br /> s : s <br /> This project is a new building or structure. , =4 _ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: l d®res <br /> ❑SEWER SEPTIC gill. e w <br /> HEIGHT IN FEET: / z Fr NUMBER OF STORIES: (Not including basement) niilitgoilia444001,4iivetedf <br /> 0 ® t° a <br /> AREA TO NEAREST SQUARE FOOT: € <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) : <br /> 4, TOTAL SQUARE FOOTAGE: 4. r `r ; t°° ' <br /> BASEMENT: 1ST FLOOR: <br /> 2ND FLOOR: 3RD FLOOR: q)0 5CR /^t <br /> _ a$1 e cep t <br /> ESTIMATED CONSTRUCTION COST: Cx,y+, OPNI- <br /> (Please round to nearest dollar) "� "� /mil//�� ;k;4444:4110 z - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes No Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Li, (Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? `L7 Yes ❑,, No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L`"J No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (lve blank if none) <br /> 6. Is a location survey required? (see reverse) Yes ❑'No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />