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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C --TOMER TO PROVIDE <br /> OWNER NAME / hI 1/4, Z z <br /> /��1 ht �i'/ � Zoning Status; CUP; <br /> OWNER ADDRESS ( umber, reet,City, tate,Zip) ed Restriction; CSM <br /> �V 7 g/I-7 1) $7 %7L �/7 �3 s--s7, ariance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS / // <br /> 6a9 .2/2--s:�s d 01 - ' 4 rr1 6 Lo (0 ' ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AczEN T NAME CONTRAC,TOR NAME // > <br /> J 01 J cc e c iL l?/eye�- - e,/,/, hi C ❑S'a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> P-Y7 4/4 ■7ir 33,E 3 Me;et- <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> �h�r �( S3 sg5 c %L ct �3 7/S7 <br /> PHONE PHONE ❑Si a Plan proval from <br /> d �� /7 s -( (,, d3 S"2s--3 . c / plic etownship. <br /> E-MAILADDRESS // / E-MAIL ADDRESS <br /> ‘o4-Jac c .Cr@ 6 4vu . c_a `-e /pe t'' '/C 474 o .ccD /97 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> ❑PARENT PARCEL NUMBER: CURRENT NING: 1 ACREAG P p y <br /> PARCEL (( '•.c) <gl,O .. a frontage drawn t ale. <br /> NUMBER <br /> TO IP: SEC O^� N.„)f J <br /> ilk-4,56,1 / S�iiy/s f I 1/4: 1,__ '/4'/4: /� ❑Driveway rmits <br /> ADDRESS ,\ /��(" (state ounty,town) <br /> CSM: 7 7 LOT /� SUBDIVISION �/ o�o ._ _ - ❑Sanitary rmits <br /> (public, rivate) <br /> PROPOSED PROJECT INFORMATION , STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> S//-ed 0 0 ❑ Zoning District <br /> . EiThis project is a new building or structure. ■ Permitted Us' ? <br /> This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ddress <br /> EWER EPTIC ■ (new/ Cistln <br /> HEIGHT IN FEET: C NUMBER OF STORIES( (Not including basement) <br /> (/ ❑ Wetland/Flo lain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i <br /> BASEMENT: 1ST FLOOR: a q v ❑ ErosionControl It <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,dist ante, <br /> 2ND FLOOR: 3RD FLOOR: lx qo filling/ac s) y�� € <br /> ❑ Review Location Survey <br /> CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 060 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies 13No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies IFINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No <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) lA5'es lalo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes a'Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -4 <br /> 545-112(4/08) <br />