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• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdanfa.com <br /> • <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME ' ( \ , A • S Lc- C • ' ion g Status;CUP; <br /> OWNER •. Ss Mu .r Stmt D Restriction;CSM <br /> is I ,iL r M �1��� Al z dance(#___----) <br /> HO E PHONE CELL PHONE E-MAILADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION andindudes di s <br /> CONTRACTOR NAME <br /> AGENT <br /> n_ k ,i we ❑ its Pia uding location <br /> AGENT N (/Y l CONTRACTOR ADDRESS of pticA ` , C� <br /> setbacks NI e£c; <br /> (City.Sil..Zlp) (c+►a Sulk ZIP) Seth CA PN e ' c l <br /> PHONE pHONE . • ❑ Site Plan - •'. • :I from <br /> -township: <br /> E-MAILADORESS E-MALADDRESS ■ .. plans to scale <br /> PROPERTY LOCATION INFORMATION (http:,accessdane.co.dane.wi.usf) e Elevation of propenY <br /> r. <br /> ❑ ? a©S`1 G6 1 2^' \g frontage drawn le. <br /> ,'OwNSHBp �7� SECT4Okk, ❑ • permits <br /> a_ 14: .S\ '%t4' ( ,county,town) <br /> ss: <br /> , 7 / ; • 'I 011 0 (A) 1 m Sanitary permits <br /> CSM: LOT SUBDIVISION : .'' ' (public,pdVate) <br /> PROPOSED PROJECT INFORMATION ;,� 1 <br /> PROJECT dESCRIFIION)J^� y� _ 'y� 1„ ,, } ' r t(l1 Vim/ <br /> Vw b ildi I v Sre. C <br /> is project is a new building or structure. ('I`(, <br /> 0 This project is an addition/alteration to an existing building or structure. 1 <br /> SANITARY SERVICE: PERMIT NUMBER: 5 40,6,❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: X / NUMBER OF STORIES: IndudinQ Warning. }R_ <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside dimensions Including Unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 0 1ST FLOG . r ( 4 TOTAL SQUARE FOOTAGE: <br /> 2ND FLOON: q.9 Q 7RD FLOOR `Ji�I/3 C . A A __ <br /> (TJt1 ■ 0 <br /> ESTIMA1•ED CONSTRUCTION COST ♦ ♦ ,♦ ♦ ,♦ ����/ �� DO <br /> (Please round to nearest dollar) !a(�D l <br /> �j Q Don't know <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ayes ,� ij Don't know <br /> 2. Is there a wetland or floodplain on or near the property? N <br /> 3. Have you talked with the township about your project and are they in agreement? ales 0 tt19. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes UdNo <br /> 5. Is this project associated with a rezone/CUPNariance(petition/appeal# ) ales blank If none) <br /> 6. Is a location survey required? (see reverse) <br /> Iles ❑ Q Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) "► -P "'e <br /> Alai <br /> 1 , <br />