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I4y i, ■i <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW NAME //i� <br /> 1 16,r toeeT2-ter ' oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) C�,4 +V4&CZ./ _ S3S5 Deed Restriction; CSM <br /> G‘7'S-6 NA?Uieer i/a/4/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60e;MS, ,t j i e4i • • 1`CIOu Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON CTOR NAM <br /> i •,pkw ,4S', ) [-'ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /1/4e0 e0 /3e,,,ed vay/ <br /> (City,State,Zip) (City,State,Zip) U2 tbacks <br /> S,ti PRA ,•Q,E 6v,- s <br /> PHONE PHONE Ite Plan approval from <br /> 6 Utk-24 2..-Z3&Z applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ez-�s�eocirde - r .rrloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> ❑NUMBER M641 - j'3-1Ogq-Q - 0 • c.I ( frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 3 1/: c w %1/4: s t j aljriveway permits Ir <br /> ADDRESS: I ' (state,county,town)N <br /> N + \141112 10 <br /> r unitary permits IA <br /> CSM: LOT , SUBDIVISION BLOCK/LOT <br /> to N4-vuct UQ t <br /> r. (public, private) <br /> & r, v i..e . . . I i of 'e"e. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION/ 9 <br /> /i cI 3 Sf�So✓ Coo - /, £r. s-Ti;-of F.cs� Zoning District <br /> . <br /> This project is a new building or structure. ❑permitted Use? <br /> ,.This project is an addition/alteration to an existing building or structure. �1 <br /> SANITARY SERVICE: PERMIT NUMBER: JJ Rural dress <br /> FIEWER kTEPTIC (new/ xlstln <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ��/ <br /> �y /Pos,�- / S� LJ Wetland/Floodplain/ilk <br /> Gf° ' Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: -ErosionControl permit �' <br /> 4, TOTAL SQUARE FOOTAGE: ,+, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: qq filling/access) <br /> / l� <br /> J,Review Location Survey ( <br /> ESTIMATED CONSTRUCTION COST: -0 -0 -0. -0 -0. -0 and available options. <br /> (Please round to nearest dollar) sir 04Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes,i0No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies ZiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? S'es FIND <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElYes ❑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) ❑YesNo ❑Don't know <br /> 7. Is this to correct a violation? FIYes . 1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ - <br /> 545-112(4/08) <br />