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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> 1(p 11A) .jr rhor1Ses Z LC- Zoning Status; CUP; <br /> OWNERA ADDRESS (Number,Street,Ci ,State,Zip) De d Restriction; CSM <br /> 2 c.(2 Z Lk)a..4.4 ivovte �� Gila,"Scj, �t 33713 V lance(# ) <br /> HOME PHONE CELL PHONE E-MAIL E MAILADDRESS <br /> • , ' —7j 7t .Po ,e q to e s r-S ,rorq 4‘.4.'rs, i <br /> to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION � nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑S. a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ ite Plan ap al from <br /> licab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL Vila Dell"'0Y3-boo-8: A-1 0 x� 47o frontage drawn to scal . <br /> NUMBER <br /> TOWNSHIP: SECTION: Ai di l.1 '/ c Cs wl 3? <br /> P�e4$GUT- S ri;vl1 Xi—A-1/ %: 4' 1/%: �- ❑(stae, rmits <br /> ADDdE S: 1 v `^ (state, ounty,to <br /> 2 7 1 I.U�S)--- $ R eo� �`/D lirr Gt>r S 3.S- 7� ❑Sanita ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pub. , private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / I$CY% e AJ h o sA.SP I/ ►' Zoning District 01 LI <br /> . El This project is a new building or structure. ` Permitted Use? <br /> ❑This project is an additio alteration to an existing building or stru ture. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' = a - <br /> FIEWER EPTIC (new/-J ting <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not i uding basement) <br /> 47o i ❑ Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) (attachmen <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) .---, ErOSIOnCOntf01 permit <br /> BASEMENT 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: �? <br /> t Z ti C`UL/4/ ❑ Review Location Survey 0 <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ -► ' and available options. <br /> (Please round to nearest dollar) / /7 c20 t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ij f o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies ❑K)o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ❑No ,' ,ye Y"" <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes ONO <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) [Yes ❑IGo ❑Don't know <br /> 7. Is this to correct a violation? Elves to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -0 <br /> 545-112(4/08) <br />