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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION Cu •MER TO PROVIDE <br /> OWNER NAME • sr wing Status;CUP;• <br /> Ve • � i c_L.6 . <br /> OWN R ••RESS(Num• abat..�) Restriction CSM <br /> '" 0 � A1e ! . 11 a' l or 113 ce ut,___) , <br /> �- N <br /> /� 3t <br /> CELL PHONE E MAILAOD: Site Plan drawn to scale �e f <br /> I� I:�iw <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indude8�rnensionsk e(.J <br /> Acre w ME CONTRACTOR NAME ❑ Pla udin9 kx;ation <br /> _A �� CONTRACTOR ADDRESS of optic <br /> . .(f 5 <br /> (CRY.BtACilp) (GIy, Setbacks 1 C V \ A'_e e Q—}i&A•PHONE PHONE 0/St hi from <br /> e)township: <br /> E-MAILAOORESS E-MALADDRESS 11 .. plans t0 scale <br /> PROPERTY,LOCATION INFORMATION (http:laccessdane.co.dane.wi.usr) J Elevation ofproperlY <br /> men. ."-•'. 'g ' -• .4 ;-;., ..--Air ACREAGE '1 frontage drawn to <br /> TowasiuP lid ❑.D rm.- <br /> AD E � �-� ,�. S 1 ,fit/: ,town) <br /> `�� $q Ot/c 1 at'44x-ou0 U4J Sanitary permits <br /> GSM: LOT Su•• •N kti J)�BLOCK/LOT (public,private) <br /> / tab . 11 - <br /> PROPOSED PROJECT INFORMATION <br /> • PROJECT DESCRIPTION: S re-.- �1.J a,fiJ l �1 / `,� • <br /> . This project is a new building or structure. ("C cC V ` <br /> CI This projects an addition/alteration to an existing building or structure. <br /> SANITARYS • PERMITNUMBER: n <br /> SEINER ❑sEPTIC U <br /> HEIGHT IN FEET. NUMBER OF STO (Not Including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside,dImensions Including Unfinished area,attached garages and above grade decks or porches) <br /> BASEMEN J <br /> m ! 58 151 FLOO� .1?6 • <br /> TOTAL SQUARE FOOTAGE: <br /> 2ND FLOG 3RD FLOOR <br /> . � -t_ ►�-- 3 `1 <br /> �1� vv <br /> ESTIMATED CONSTRUCTION COST -► -► -4. -► -► -► ,P ` 7 �0 <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? D Yes o C".3 D t know <br /> 2. Is there a wetland or floodplaln on or near the property? OW, <br /> 3. Have you talked with the township about your project and are they in agreement? (2/es ❑yo <br /> 4.Haa there been a zoning permit Issued for this property in the past 5 years? ❑Yes UNO <br /> 5. Is thid project associated with a rezone/CUP/variance(petition/appeal# ) (Iwo blank If none) <br /> Wes ❑No v Don't know <br /> 6. Is a location survey required? (see reverse) p,� <br /> T. Is thi to correct a violation? ❑Yes L i 0 . <br /> APPLICATION MUST SE SIGNED <br /> • <br /> (Continue on Back) -► -► <br /> Noe <br />