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VSUPPLEMENT to Web-App#?ZONING PERMIT APPLICATION .countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE•$NAME ` , `Io\ S Lam-6- oning Status; CUP; <br /> OWNER ADDRESS (Number,Street, ,State,Zip) <br /> Pc,23x (p2o3ac �°dat t� ,-, / W� 3s" Z Variance(# SM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 333-- /I,c9 s' s (A- - s.- <br /> Gw, ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and i cludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> "" • : 1V5 5 _ ite Plan including locatic 7- <br /> AGENTADDRESS CONTRACTOR ADDRESS of w /septic <br /> 7c,,a-k Ce'?-0. 0c <br /> (City,State,Zip) • (City,State,Zip) Setbacks <br /> /1')� Ie w, -"1-S- 2.- <br /> PHONE PHONE Ite PI r from <br /> Laois -333`y�s-y app• tainship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,,,', dsQs,� _ Mvo1•S-` Floor plans to scale • <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> ❑PARCEL 6-�c,�„0SY_ _4 ez eL /s <br /> NUMBER frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 11(• �_ jo �-- ,/4. ,/4,/4: Iveway permits <br /> ADDRESS: �^��- (stat county,town)LA/2 _S-35e 2- y)Ar. <br /> CSM: LOT / SUBDIVISION BLOCK/LOT anitary permit <br /> (public, private <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW 1 ?" <br /> PROJECT DESCRIPTION: <br /> 12 t'q- . lal'--S `10 X.80 orals DiStnCt <br /> [This project is a new building or structure. *PO Use?, Rf �-, <br /> This project is an addition/alteration to an existing building or structure. ` <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> braid• <br /> EWER [EPTIC (new]- Is mg) t}1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> l q 1 M ern 1 �x,etaandloodplainl <br /> Shoreland (attacbrnert) <br /> AREA TO NEAREST SQUARE FOOT: , $ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ® 4 ". ."3 , fi �d-�� <br /> BASEMENT: 1ST FLOOR: rosionContrO1 permit <br /> 1 ac c) TOTAL SQUARE FOOTAGE: S ea dISsUrbaOCe <br /> fillingiaccess <br /> 2ND FLOOR: 3RD FLOOR: t t�] r.-� 'w.-- <br /> L/�� ; view tlon�5uivey= i <br /> ESTIMATED CONSTRUCTION COST: ariij av table opions � <br /> (Please round to nearest dollar) <br /> �� , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Plies No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? �fres ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes KNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (lea a blank if none) <br /> 6. Is a location survey required? (see reverse) es No ❑Don't know <br /> 7. Is this to correct a violation? Dies po <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08( S ua r4--.S (Continue on Back) -► -♦ -► <br />