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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME <br /> Pia i LI P PRZ 3- 1 V Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Restriction;CSM <br /> Bq 2(( (01-011 g-6 <br /> aria riance(# ) <br /> HOW_PHONE CELL PHONE E-MAIL ADDRESS <br /> Z( - S' a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 'QICK u&lIes, &. le- CLC, Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> ?mil ti to(Iis r- 4ve <br /> (City,State,Zip) (City,State,Zip) S tbacks <br /> WA-615011 W- -5 72-6 <br /> PHONE PHONE Site Plan approval from <br /> &OA'-2a. - ?clay applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rt(k wr w bur (d•row, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE TZO ING: ACREAGE: LI Elevation of property <br /> ❑ PARCEL Q 6,07333cf tr j,O frontage drawn to scale. <br /> NUMBER ''V+ <br /> TOWNSHIP: SECTION: <br /> Si', 041,E ;'j '/: Su, '//: 5(.0 Li Driveway permits <br /> ADDRESS: �J ,!, (state,county,town) <br /> gq G i wL43 '7 4D , ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> max: <br /> ADD A Zdxza ?-ND t,EVE 1- - : ' ;Ir <br /> :715"e'l*ilittig"17124414V <br /> . pi>project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. ;. .': 5, <br /> SANITARY SERVICE: PERMIT NUMBER: A v max.= <br /> ❑SEWER SEPTIC = 11 .,-fxfsti 1 <br /> HEIGHT IN FEET ow 1 / NUMBER OF STORIES: (Not including basement) ° <br /> AREA TO NEAREST SQUARE FOOT: t'- $. ) xz <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) w 1 , <br /> BASEMENT: 1ST FLOOR: e :-„..,14r. <br /> 4, TOTAL SQUARE FOOTAGE: + �. s :a. , <br /> 2ND FLOOR: 3RD FLOOR: �`- <br /> Loo <br /> t <br /> ESTIMATED CONSTRUCTION COST: `" <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ avai a' : t? € 52 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'Flo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ..1;i1Cro ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ..LJITo <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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► <br />