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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 L L,(.�, <br /> ___,.'j.{fir:._.��11��;.ar3=.�.--r <br /> .:.. �..� ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Nu •er,Street,ACity,State,Zip) 11 II Deed Restriction;CSM <br /> Z la PHONE , I SJts)bra i 14 ���3 Variance(# ) <br /> HOME PHONE ��11// ��r CELL PHONE E-MAIL ADDRESS G„' r,W .' + <br /> ?.X.3” Z-lb--� -Nall Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME i CONTRACTOR NAME <br /> i3.4P lt. 1\4uc . z A )4 Q4 7, �.,LL. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ' of well/septic <br /> (City,State,Zip) • (City,State,Zip) ❑ Setbacks <br /> 1 0 141 S3 hA0,.1.M.46' ) <br /> IA 3 7I <br /> PHONE PHONE ❑ Site Plan approval from <br /> • Z.3 • 53) a • 222-' Z4Z f 1323 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1 _ - b_N 6 �. •_ , L�FtIQlans to scale <br /> PROPERTY/LOCATION INFORMATION (httpd/accessdane.co.dane.wi.us� ❑ Elevation of property <br /> PARENT PARCELNUMBEER�{ ���( CURRENT ZONING: <br /> ja CI. ACREAGE: <br /> NUMBER 032 r•�" / -7T'� cam ' 1. 0,� 1 frontage drawn to scale. <br /> TOWNSHIP: 7. '. .0 SECTION: <br /> !"Ii.�IAN 3'S '/a: �j� '/a'/a: j` .. ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> t1 1,4. }�1�� , � �t4 , 14I 53713 <br /> cSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> 1 a (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /"M t4 �. <br /> CI Zoning District <br /> . ❑This project is a new building or structure. LI Permitted Use? <br /> lit This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: CD Rural Address <br /> XSEWER ❑SEPTIC j- �,�, �Q (new/existing) <br /> HEIGHT IN FEET: d NUMBER OF STORIES' ( mduding basement) <br /> Z." . cj Q C. 0 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: ' J Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> �^ 1 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> N'�'b`� "7��'� filling/access) <br /> 2ND FLOOR. 3RD FLOG <br /> 1'..17/ kiA.• 70.000/ I L-� Q Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 'Cia and available options. <br /> (Please round to nearest dollar) ♦ ♦ ) CQ� ;"�- <br /> ,it I,400.cc, PER.itoT Fee <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yes No Li <br /> know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes Li <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes ANo <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) CI Yes A No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -0. -► -► <br />