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SUPPLEMENT to Wcb-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V e ik c t, a n Om.e_s L L C ❑ zoning status;c UP, <br /> OWNERADDRESS I , City, . Zip) I _ j�� � Deed Restriction:CSM <br /> o IA _al�si it 1 N �') . ! i l 5 7! Variance(#�---) <br /> • E PHONE CELL PHONE E•MAILADDRESS to scale <br /> A 41 <br /> 0 Site Plan drawn <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and indudesdimenOns <br /> AGE ' CONTRACTOR NAME ❑ Site Plan including location I A F fit► t U-e of well/septic d .:-, ; CONTRACTOR ADDRESS <br /> ❑ Setbacks . <br /> (City,Mom,210 PAY.Skis.ZIP) • <br /> ❑ Site Plan approval from <br /> PHONE PHONE applicable townshIP' <br /> E.MA LADORESS EMAILADDRESS ❑ Floor plans to scale <br /> PROPERTYiLOCATION INFORMATION (http: accessdane.eo.dane.wi.usf) ❑ Elevation ofpropertY <br /> PARENT <br /> El PA PARCEL NUMMER C 9 frontage drawn to Scale. <br /> \ SECTION: ❑Driveway ) <br /> TOWNSHIP SECTION: <br /> 1". �______ Wt" <br /> Roo J$ .3 L- u " i ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION 81.E-OT (public,private) <br /> •ROPOSED PROJECT INFORMATION <br /> pRO.IECrDESCRIPTION: .(2._ /,,�,, i �T -6 _ i . <br /> . is project is a new building or structure.v 1!�(.0 J l�J U <br /> Cl This project is an addition/alteration to an existing building or structure. <br /> SANITARY IE R= PERMIT NUMBER: <br /> '— O & ' / Z <br /> ❑SEPTIC 13 s <br /> HEIGHT 14 FEET: '!I MASER OF STORES: (Not Including bomo ) <br /> a� AREA TO NEAREST SQUARE FOOT:above grade decks or pordtss). <br /> (Outside dimensions including Unfinished area,attached garages <br /> BARBER 1ST FLOOR: TOE,8OUAIlE FOOTA <br /> 2ND FLOOR:/5" / 3RD FLOOR 4 53 8''k:ESTIMATED CONSTRUC110N COST. --► -► -► -1. -► l A or 00 <br /> (Please round to nearest dollar) <br /> Q1 t,� 0 Don't know <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑ e . 1:3 Don't know <br /> 2. Is there a wetland orfloodpiain on or near the property? ❑N <br /> 3. Have you talked with the township about your project and are they in agreement? 9_ <br /> 4. Has there been a zoning permit Issued for this property in the past 5 years? ❑� QN <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#_______., gz blank If none) Don't know <br /> 6. Is a location survey required? (see reverse) <br /> °Yes <br /> T. Is this to correct a violation? <br /> APPUCATION MUST BE SIGNED . <br /> . (carnaue on BaciK) -• '♦ "e <br /> .,s <br />