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SUPPLEMENT,to.Web•App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWN R NAME f€ <br /> lam' �� /1 Loning District <br /> OW 9 (Number,Street,City,State,Zip) <br /> e 7 59 tJQ if'oiPe/Cl i d sCicr / J lC C7K (.4..) : �3c/3 ; ;Permitted Use? <br /> PHONE / E-MAIL ADDRESS • = <br /> • •: s — s : 6 j Zoning Status; CUP; <br /> AGENT INFORMATION CONTRACTORINFORMATION Deed Restriction; CSM <br /> AGENT NAME CONTRACTOR NAME Variance(f ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to scale <br /> and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> D. Site Plan including location <br /> PHONE PHONE of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ' <br /> 2 Setbacks <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wl.usn '.T ❑ Site PiaJLapprovai from <br /> PARCEL PARCEL NUMBER: q �n p ZONIN I ACREAGE: <� a Ticabletovvnshlp. <br /> NUMBER 65,019 -�; f-��17�— S V —� _ <br /> TOWNSHIP: ��(( SECT . ❑ RUfaldreSS <br /> K C) x lo U r & r '/4: N ./'/o: N W Ru existing).zv--- <br /> ADDRESS: z (,/,,.. 9 <br /> U 2 Fioor plans to scale <br /> CSM: LOT SUBDIVISIOtyA (1 BLOCK/LOT '"1 / <br /> We x-\I r AN <br /> re ^�Cl LF'Elevation of property <br /> ' i ' ' ' . i ' ' j ii = ' '" frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> Q ✓C ° �'a <br /> v s <br /> . ❑This project is attlew building or structure. (state, county, town) <br /> ❑This project is an addition/alteration to an existing building or structure. ---- <br /> Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER SEPTIC (public, private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) r <br /> /� ! l /� / :� WetlancflFio�c3plain/ <br /> f <br /> 7 t� ._Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) o <br /> ❑ ErTonControl permit <br /> BASEMENT: 1ST FLO <br /> f CAC? 1 TOTAL SQUARE FOOTAGE: (slopes, disturbance, <br /> ( filling/access) <br /> 2ND FLOOR: 3RD FLOOR: f it <br /> N'DNF /v0 e `7' x (0 ", ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -► L �� and available options. <br /> (Please round to nearest dollar) / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LYeS LNo ❑Don't know <br /> 2. There is 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? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI 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 Lallo ❑Don't know <br /> 7. Is this correcting a violation? • ❑Yes ®No <br /> r--- <br /> \∎111 —�__ APPLICATION MUST BE SIGNED <br /> 4 � , <br /> (Continue on Back) —► -► -► <br /> 545-112(1/08) <br />