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S • Lf -5P , 13 - • <br /> SUPPLEMENT to Web-App # <br /> 1-I ZONING PERMIT APPLICATION www. dane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 1 , OWNERN M- i � • <br /> 1N e- • ' A ` oTY1.'' S ( L ( ❑ zoning Mattis;CUP' <br /> ' V Sent, • , ) . 539/3 Deed{diction;CSM <br /> / SS(Number, ~i, I ' ,. I,� _6\ Z Variance(ft,_--) <br /> -- . CELL PHONE E-MAIL RESS 0 Site Plan drawn to scale <br /> I )_ AGENT INFORMATION CONTRACTOR INFORMATION and I��dimensions <br /> V V <br /> AGENT <br /> F ADDRES <br /> CONTRACTOR ❑ site Pan indu <br /> dln9 locate <br /> ,--�ENT 'k� ` U ,k <br /> S CONTRACTOR ADDRESS of welUseptIC <br /> n <br /> (ceY S Yb.ZIP) (ebb ,ZIP) ❑ Setbacks <br /> f ' ❑ Site Plan approval from <br /> PHONE PHONE applicable township= <br /> SE-MAIUIOORESS . E-MALADORESS ❑ Floor plans to scale <br /> i4 PROPERTYILOCATION INFORMATION (http: accessdane.co.dane.wi.usi) ❑ Elevation of PrOPeitY <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE. frontage drawn to Scale. <br /> 0 mom TOV NSHP\p SECT tt 9 t ❑.Driveway permits <br /> 1 I � �I 1�4. _ /414 (state,county,town) . <br /> 35 1 '5. L.G Q'iru2 ❑ Sanitary Permits <br /> LOT • SUBDIVISION Pali DLOCKILOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> . PROJECTDESCRPTION: F — 0 04114 . <br /> . his project is a new building or structure. <br /> ❑This projecttis an addition/alteration to an existing building or structure. <br /> � <br /> PERMIT NUMBER: / - 2 f„ <br /> NJ S ❑SEPTIC `5l/ <br /> HEIGHT IN FEET! A 5/ , i NUMBER OF ST (► I^0 ) <br /> � a1 <br /> AREA NEAREST SQUARE and above grade decks or porches) <br /> .(Outside dimensions including unfinished area,attached garages ga <br /> BASEIEENI. 1 CJ i 5 isT l 1 3 f V(0`1 j TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: A n�- 3RD FLOOR: (23-77)• ` 5237." <br /> ESTIMATED CONSTRUCTION COST: -► -► -� -► -► -► $ 'd <br /> (Please round to neared dolor) <br /> `� aPo Dyes CI Don't know <br /> 1. The property Is within 300 feet of a stream or feet nd or lake? ❑ 0 Don't know <br /> 2. Is there a wetland orfloodpiain on or near the property? <br /> 3. Have you talked with the township about your project and are they in agreement?.... Cliiis 4.Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IfdTlo <br /> - blank if none) <br /> 5. is this project associated with a rezone/CUP/variance(petition/appeal#____--, (I ❑No 0 Don't know <br /> 6.Is a location survey required? (see reverse) ❑Yes <br /> 7. Is this to correct a vidatlon? <br /> (�nuaon MUST <br /> t3actK) BE��♦ <br />