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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 S";_QjV ` <br /> OWNER ADDRESS (Number,Street,City,State ) ` Z mg Status; CUP; <br /> 2 , Z9 &v C/` t 2 4'\ �v��i'�gQ._ *I\ S' 62 3 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE z-I23 CELL PHONE E-MAIL ADDRESS <br /> 60 '- -" ILl' 603-601 'OS 69. sAeve.'�eA 2e\@ ck2 .C-3,(\r■. • Lite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME !� ,,� <br /> 1 d NI i (in{ III ii v.-k t�" L�2ff Plan including location <br /> AGENT ADDRESS CONTRA OR ADDRE sal' of well/septic <br /> wffila � k �J <br /> (City,State,Zip) (City,Stat¢t Zi �, acks <br /> tt��yk4.r, ( 1%r 53S'LS <br /> PHONE PHONE SI an approval from /, <br /> 4 31 LI 1 1-35 applicable township. / t <br /> E-MAIL ADDRESS E-MAIL ADDRESS l <br /> VQo. .H 191„l I. 6 dpi ,0w or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) /atlon of property <br /> PARENT PARCEL NUMBER: CUR ENTZ DOING: ACREAGE: v P P y <br /> ❑PARCEL ) �j /� ���, ,` frontage drawn to scale. <br /> NUMBER 66,` — (�1 -crino—c� A 1 - ' <br /> TOWNSHIP: l SECTInrh-l: * 1 r 1 <br /> 1 X' 1 "y 4- 1/41/4: c W ‘way permits A/A <br /> nDRESS: '^nn /�/V� (state, county,town) <br /> cs. , 1 �6- f SUBDIVISION BLOCK/LOT '❑unitary permits _Al 14 <br /> (public, private) T <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / / <br /> \N shy 0\rc\.-- __ 3 y Kay q7,d3hing District <br /> This project is a new building or structure. aPefrnitted Use? <br /> This project is an addition/alteration to an existing building or structure. L <br /> SANITARY SERVICE: PERMIT NUMBER: p ai Ad r 1 C <br /> F1EWER MEPTIC <br /> (new XlSting) <br /> HEIGHT IN FEET: ) NUMBER OF STORIES: (Not including basement) <br /> /J 1 ✓ Q ` LiDatf e /F000dplain/ <br /> 1 Shorela land (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: OSIOnControl permit <br /> © 61 / 1 TOTAL SQUARE FOOTAGE: + (slopes,disturbance, 1 <br /> 2ND FLOOR: 3RD FLOOR: M / filling/access) r ) <br /> © 0 S 110 C -review Location Survey N'" <br /> ESTIMATED CONSTRUCTION COST: 0> and available options. <br /> —0. -0. -0. -10 -0. -0.(Please round to nearest dollar) 2 S iv- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes JNo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No 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 NNo <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) Ekes No EDon't know <br /> 7. Is this to correct a violation? ['Yes no <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />