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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME l 11 <br /> YV 2\.Qr VoSor" ❑ Zoning Status;CUP; <br /> OWNER ADD EE1SS (Number,Street,City,State,Zip) } Deed Restriction;CSM <br /> 2sys-7 SbAinp D('eJQI STeu3\'tOr ,LOX S358'`t Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS t�c� <br /> 3,1s- u, & 6c. 3yS-�II a J.vk are,1n IV.r∎g 't,-)c ,cCn•, ❑ e Plan drawn to sca <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensio <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ���� .ra,- fro <br /> `I:pp Ica.a townshi. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL o frontage drawn to scale. <br /> NUMBER O 1 —c t( `2 zlss.C'o 2�t ,_Z <br /> TOWNSHIP: SECTION: <br /> Ple ■ „- (t '/a: '/a'/a: CI Driveway permits <br /> ADDRESS: ` (state,county,town) <br /> a OS y SZy 1, . Z(,viz. Stou��.� , (A)I S 358 9 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> X033 a <br /> PROPOSED PROJECT INFORMATION IE ' <br /> PROJECT DESCRIPTION: , <br /> 1V S�„Qa s :_ i st <br /> This project is a new building or structure. ; <br /> ❑This project is an addition/alteration to an existing building or structure. .vim <br /> SANITARY SERVICE: PERMIT NUMBER: " <br /> •. o <br /> ❑SEWER 4 SEPTIC V:^:1 t o o iti <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ti <br /> 0 Dos <br /> lo' NIA '' <br /> t) <br /> AREA TO NEAREST SQUARE FOOT: 7 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - < <br /> BASEMENT: 1ST FLOOR: ;4 =:' : <br /> > > 4, TOTAL SQUARE FOOTAGE: 4, • . .- wr45 <br /> 14xt� <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -► �y� ,a I ' Z <br /> (Please round to nearest dollar) )1 R � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L'J No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? (ii Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Oyes 0j.lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? . Yes ICJ 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) ❑)('es ®No ria Don't know <br /> 7. Is this to correct a violation? Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545112(a/os) (Continue on Back) -0 - . -► <br />