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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 �/�ry`'�t� <br /> OWNER ESSi1 ©ber, 14 City,State,Zi Zoning Status; CUP; <br /> 10"--- (`‘ r, r 1�l f_ 4-,"CI Deed Restriction; CSM <br /> jV\ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS r <br /> 3, - • , 'J/Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG T NAME ` CONTRACTOR E ;; <br /> I J� �1�eAP-A? - Gi,,.---b�e 5VI. .--, E ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Et/Setbacks <br /> f\l.\ k.ov\ U\ s3 ? iii <br /> PHONE PHONE ❑Site Plan appr66al from <br /> 6 0 - y y+.-} — )7.3 applicable-township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ,-,,� <br /> G,`c 1,-K' robr. ?ksj - h ei door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: A REAGE: <br /> PARCEL p frontage drawn to scale. <br /> NUMBER b3'^ 07 t�C� 3)1-13714 <br /> TOWNSHIP: SECTION: <br /> Mlf <br /> F <br /> /OUr, 1/41,04 1,._ 7 r ,/a: , h: Driveway permits <br /> (state, county,town) `L.J <br /> ADDRESS: L/ <br /> ■—.) l L ' C r C c u t^ t C1,Sanitary permits )r e -F.- <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> c2 I PUP-II SON, (public,private) 1 C i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / / Z4"_ g <br /> C �,.r v onin District <br /> . his project is a new building or structure. ❑ Iermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. �t <br /> SANITARY SERVICE: PERMIT NUMBER: Q -i-Rural Address <br /> rwEP <br /> EER TIC 73-a op- Oa?/U ( (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ., <br /> 2,_Z 1 .2 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> /1 4, TOTAL SQUARE FOOTAGE: j (slopes, disturbance, <br /> "✓` 7T--/-0 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: `. , 6 <br /> t <br /> /7 b - 1 ,' ❑ Review Location Survey 1 v <br /> � <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) —I. --o. "■ -4. 7_5 0 DV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ❑NO QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes Elko ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Elves Elko <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves [ rNo <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) Des Elio QDon't know <br /> 7. Is this to correct a violation? Lives to <br /> __t. 4-N.,, s . iv' APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br /> 1,738 <br />