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SUPPLEMENT;to Web;App#'. <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> STiir£r' -D NA1t/id ❑ Zoning District <br /> OWNER ADDRESS (N4imber,Street,City,State,Zip) <br /> 7y6G. n usi ± kci . 5ur1) Rzt.z.R1r ) wSSG, 5-,3 S-9a ❑ Permitted Use? <br /> PHONE 'E-MAIL ADDRESS 1 <br /> •off'"35 8 - 8 8 13 ❑ Zoning Status; CUP; <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME <br /> Variance(# ) <br /> 4S.C14 A a ) R-7NCE'26Ea2. <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to scale <br /> G Pd I 14-,,j ,s--) and includes dimensions . <br /> (City,State,Zip) (City,State,Zip) <br /> /-,F rQ- +.1 WI-C. .�3S34 ❑ Site Plan including location <br /> PHONE PHONE of well/septic <br /> Cook- 999- al3oy <br /> E-MAIL ADDRESS E-MAIL ADDRESS • ID Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wI.us/) =-• ,_] Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: applicable township. <br /> ❑ NUMBER 0/VOW/ /O V-83,10-/ " -? ' 5i /3 y <br /> TOWNSHIP: SECTION: ❑ Rural Address <br /> Sri 5.4-o) (D(?) j,,,) 1/4: S( '/°'A: S f (new/existing) <br /> ADDRESS: <br /> 7y44 21) 5S- RS, Li Floor plans to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> /1: 1 NE(A, .De c(G. (SQe. S i�e tall • ❑ Driveway permits <br /> ❑This project is a new building or structure. (state, county, town) <br /> LI This project is an addition/alteration to an existing building or structure. <br /> Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (public, private) <br /> ❑SEWER SEPTIC <br /> HEIGHT IN FEET: 9 NUMBER OF STORIES: (Not including basement) ❑ Wetland/FIQOdplaln/ <br /> o 'j �c/ i 1 o i / Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT: 1ST FLOOR: 8 <br /> ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 163 1. -C ., <br /> fl <br /> T ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d� 8O0 and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ •p `�� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes fid No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# , ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ®No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes IN No <br /> 2/ / 19 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -- -+ -9. <br /> 545-112(1/08) <br />