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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 n 0'115 c' k1 ` ,'Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) `�"Deed Restriction;CSM <br /> °t Le S ci rt. • 'Re✓/ G.k A -t1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> CO 0% -3'33- 30 12_ J o11% c",01 ka 3( 4) ' $ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION �nd <br /> includes dimensions <br /> AG T NAME CONTRACTOR NAME r <br /> 0. , Yl G'Q.L1 h Cx)5�a lkoARc r LL-C- <br /> ❑Site Plan including location <br /> AGENT ADDRESS 1 CONTRACTOR ADDRESS welVseptic <br /> ' w 3-L39 ,pct `�onwovcQ 12) r <br /> (City,State,Zip) J (City,Stale,Zip) acks <br /> AL?tit(({ w% S3Sv ! <br /> PHONE PHONE ite plan approval from <br /> Uto`b cif _q S3 C.4) - applicab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Lk ,23e) q f rig;I -C.,;•,.v Igor plans to scale <br /> PROR'`IRTYILOCATION INFORMATION (hktp:l/accessdane.co.dane.wk.usl) vation of property. <br /> PARENT PARCEL, ;ER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 7. " i frontage drawn to scale. <br /> TOWNSIIIS o44 ) DSote.-121-Ofn a VN: ' ‘,..) 1/' SE ❑Driveway"permits <br /> ADDRESS: (stale, county,town) <br /> Ciat 51 E k ✓ C" El Sanitary.permits""%d)CSM: LOT SUBDIVISION BLOCK/LOT <br /> 10017_ I (Pc ovate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> V 6 V t 1 a t jet 4) 7^c...;) iii tistTlt <br /> . EgThis project is a new building or structure. <br /> D Permitt=x Vie? , <br /> This project is an additior(/alteration to an exis ing building or structure <br /> SANITARY SERVICE: PERMIT NUMBER: © I Rural `ddress '''' <br /> EWER ,EPTrC I j .• i jr,HEIGHT IN FEET: NUMBER OF STORIES: ( t including basement) C• <br /> !�� Q I cti l asa } , <br /> AREA TO NEAREST SQUARE FOOT: - 4 (attaahm ), <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '~ <br /> BASEMENT: 1ST FLOOR: 0 ErosionC.. ` permit <br /> 3 7 j TOTAL SQUARE FOOTAGE: + (slope s isturtlance, <br /> ,2ND FLOOR: 3RD mess) <br /> o 3 `6 4 c e rL it Ivey' " <br /> d v <br /> ESTIMATED CONSTRUCTION COST: OW o ^ /� <br /> (Please round to nearest dollar) -► -. -4. -a► -+■' $ Z 5! �v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 15fres ao []Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,®Yes ON <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes fo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appealf# ) (leave b ank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 12islo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes b <br /> 545-112(4/08) v <br /> ���, fQa APPLICATION MUST BE SIGNED <br /> 1 �C v (Continue on Back) -• -► -► <br />