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SUPPLEMENT to Web-App# <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER AME <br /> ova c/ T � <br /> OWNER ADDRESS (N tuber,Street,City,State,Zip) ❑ Zornng OISt�1Et <br /> 4u- ,o <br /> 7[JO9 r�av Lt t' urn / -,e G.�L S";�59�62/� Permitted USe?- <br /> PHONE E-MAILADDRESS <br /> Zdning Status,CUf=, <br /> AGENT INFORMATION CON7 RACTOR INFORMATION bead Restriction CSM; <br /> AGENT NAME CONTRACTOR NAME rice <br /> �dria <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Slte Plan drawn:to scale <br /> (City,State,Zip) (City,State,Zip) and includes dimensions <br /> Site Plan including location; <br /> PHONE PHONE ,of welll/septic <br /> E-MAILADDRESS E-MAILADDRESS ❑ Stbacks: <br /> k <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.d)ane.wi.us/) Site Plari approval from <br /> PARENT PARCEL NUMBER: ZONING: �' . ACREAGE: x <br /> q >// - a 85 i appiiicabie:township <br /> ❑ NUMBER ///- Jb2' �7/�l Z LG� - tY64C ,R y <br /> TOWNSHIP: SECTION: 0�Rural Addre <br /> { t�S t Tel_ 'a. % I . <br /> ADDRESS: t,(new/e15444ng) <br /> n <br /> rS y`/ T:,---./ c�.tc 2c) cS�^ f��r,� L12 s �S�o Floor plan s to sc le <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> PROPOSED PROJECT INFORMATION �C vage Af�ropert <br /> frontage drawn to Scale <br /> PROJECT DESCRIPTION: /01' E <br /> �p�c) s7li/r1,1:[ x(10/C 6(i/ .^f _ �_,- ye R� <br /> c� (a' � 3 C rl�ieway, n�1t <br /> This project is a new building or structure. (State,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: (public pri ate <br /> ❑SEWER I�SEPTIC <br /> a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Wetland/Floodplaln/ <br /> s Shareland (attachmeh ) <br /> AREA TO NEAREST SQUARE FOOT: t <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosiDnGii.:61 etri <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: 4, (Slopear tlisturbar)c , <br /> fiilling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 6_7 ZO <br /> Q fevtev Location Su1e <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 'S-1 , and a tatlai e options <br /> (Please round to nearest dollar) �,� t,.. ,: ` A,- _: <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li yes <br /> QNo ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? <br /> Li yes �No ❑Don't know <br /> 3. Have you talked with the township about your project? �'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <br /> 5. This project is associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes I$No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes �No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(troa) <br /> (Continue on Back) =(t ♦ -►' <br />