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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM `e ' p L t- '' ( �r� `/ <br /> ❑ Zoning Status; CUP; <br /> OWNPRADDRE S (Number,Street,City,S Kte, ip) I Deed Restriction;CSM <br /> 157b s i''k,S Ot, s fo14-"1, -r �15C. <br /> g9' Variance(# ) <br /> HOME PHO E I CEL PHONE E-MAIL ADDRESS <br /> 4/ /9 6?g- ) 1 L1 3 //7 4 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C CONTRACTOR NAME <br /> S2 k ❑ 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-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usr7 <br /> PARENT PARCEL NUMBER: CUR NT ZONING: c$ tD ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL OO//_03a_9 too-.Q C�` �// frontage drawn to scale. <br /> NUMBER 7 O J I <br /> TOWN HIP: SECTION: <br /> �I `� '/4: '/1/<: ❑ Driveway permits <br /> VIA h <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: i <br /> S A O r 5V,e0( 1 Y 1/411!ittalgttiViVia —grte) <br /> . ,X1 This project is a new building or structure. a <br /> ❑This project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE: PERMIT NUMBER: [A a W a <br /> g R1 <br /> C3 SEWER ❑SEPTIC / • a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) h <br /> t 4 ' s !a,*®a <br /> Z ® "ar ) <br /> $11t <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` : � <br /> BASEMENT: 1ST FLOOR: <br /> ` TOTAL SQUARE FOOTAGE + # 015‘44A) r '1711 •- A h <br /> 2ND FLOOR: 3RD FLOOR: A' , g ,=. <br /> 3 e_ <br /> > r� 1 y <br /> ESTIMATED CONSTRUCTION COST: •OY a OP,a <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ S t O�C7 xe t .- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes .11d No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes A No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ,N Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 4 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes X No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► -♦ <br /> 545-112(4/08) <br />