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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 a/t /� DC.AI�I o� <br /> OWNER ADDRES Number,Streett,,City,State,Zip) eed estrus;CUP; <br /> ?g / / / r r / D ed Restriction;CSM <br /> HOME PHONE 5 — CELu NE 8/E-MAIL ADDRESS <br /> 1 � '- s3 s�b Variance(# ) <br /> .,_., 5 27-075 _o- 020S- `, Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ..Setbacks <br /> PHONE PHONE -.X.Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .y"Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: • Elevation of property <br /> ❑ N EL 0, O6-.3.5/-4a00-.3.5/-4a00 .0 /1 g.-3 �3.S$ outage drawn to sca <br /> NUM UM BER <br /> TOWNSHIP: SECTION: <br /> Pn J r LE Driveway rmits <br /> ei— � %:s 1�4%: J (state unty,town) <br /> ADDRESS: <br /> .365 T va.cca! a a/.�,,c v647‘ . .S.3sa ❑ Sanita •ermits <br /> CSM: LOT BLOCK/LOT <br /> 95 7 / (pu• 'c,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> es■detal 5e7ki-Sli.l\dt n Zoning District <br /> P.This project is a new building or structure. ) A-Permitted Use? <br /> LI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT N B Rural ` <br /> ❑SEWER (EPTIC 7 (ne - <br /> HEIGHT ET NUMBER OF STORIES: (Not including basement) <br /> ( ❑ Wetland loodplain/ <br /> Shor nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) (-o„ErOSi <br /> 'a onC trot permit <br /> BASEME� 1ST FLOOR: J <br /> I� 4, TOTAL SQUARE FOOTAGE: 4, (slopes isturbance, <br /> 2ND FLOOR: 3RD FLOOR: fiilln ccess) <br /> I E 00 Review tion Survey <br /> ESTIMATED CONSTRUCTION COST: Q� nd a liable options. <br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ $ �--1 t <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes cm No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes A.No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 41-Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 44No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lo <br /> n APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112 woe) <br />