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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 <br /> •ata —e V .A LUL ./ ®Zoning Status;CUP, <br /> OWNER AD.R . (Number.'-reet,Day.Si Deed Restriction,CSM <br /> 551 0 RIs-h e- MC FOL.I oY'c V I Variance(# 1 <br /> HOME PHONE T CELL_— PHONE c.MAtL ADDRE S /� <br /> tp304S -tvPS 4rehrt6-1"e115e, = •ma,I•cc Site Plan drawn to scale <br /> AGENT INFORMATION FCONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> --T /Cil N,CA 3e&iQo Flat Fee VW C301 ®Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> o <br /> ,ca„ <br /> I,A-C A S - f cosarre.zo)Go& 2i3 ®Setbacks <br /> C 0-1k a c.&a C'wOVK' W 1 <br /> PHONE PHONE (J I 0 Site Plan approval from <br /> 1,110Q- ASS'- S 1 ( D 0%-as S—-r1 I applicable township <br /> EMAIL ADDRESS E-MAIL ADO:E S <br /> & <br /> -� ae- bt` �� Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpalaccessdane co dans wi use <br /> LMPARENT PARCEL NUMBER CURRENT ZONING ACRE E :�Elevation of property <br /> -NUMBER a1$I D1 II—101-'211$"0 SFR r� 689 frontage drawn to scale <br /> � <br /> TOWNSHIP SECTION <br /> C.c 4-ctODIS C�lrc)v�- - a---------- 'A-------- Driveway permits <br /> ADDRESS. (state,county.town) <br /> 2195 W ODED RIDGE TRL Sanitarypermits <br /> CSM. LOT SUBDIVISION ocrctOT (public,private) L---- <br /> u� <br /> g .AW.. -i. ILI <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION. ` <br /> n e Ire t ,R 1 Q.1 r rUme ( 5t , Zoning District <br /> . gThis project is a new building or structure f �` U U Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER_ U Rural Address <br /> EWER riilEPTIC (new/existing) <br /> HEIGHT IN FEETNUMBER OF STORIES. (Not Includ g basement) <br /> 15' __1_ yravKkl U Shorel d/Fioodplain/ <br /> AREA TO NEAREST SQUARE FOOT Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r-.ErosionControl permit <br /> BASEMENT 1ST FLOOR <br /> 21 S'9 -1- j C—1J 5 4 TOTAL SOUARE FOOTAGE: 4 (slopes,disturbance, <br /> 7 filling/access) <br /> 2ND FLOOR 3RD FLOOR <br /> — 5 3$3/4 0.0 <br /> j Review Location Survey <br /> ESTIMATED CONSTRUCTION COST. p 5 L4 0, ,.,,_,r, and available options. <br /> (Please round to nearest dollar) i co° <br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake'?. QYes [r 'JoDDon't know <br /> 2 Is there a wetland or floodplain on or near the property'? flYes o QDon't know <br /> 3 Have you talked with the township about your project and are they in agreement? ®Yes D. <br /> 4 Has there been a zoning permit issued for this property in the past 5 years?..__ Dees 'lo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal A ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) DYes nNo Doon't know <br /> 4 7. Is this to correct a violation? Dyes10 <br /> APPLICATION MUST BE SIGNED <br /> 4 re,01n3 (Continue on Back) —0 <br />