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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION <br /> OWN R NAME iii C TOMER TO PROVIDE <br /> 114///4 h'4//,`� 9 �.�- <br /> OWN ADDRESS (Number,Street,City,Sfate,Zip) ZI ZOn4g Status; CUP; <br /> �1 3g a c/ 44n€ S �O c �� De'd Restriction; CSM <br /> HOME PHONE CELL•HONE f� E-MAIL ADDRESS S�' 1 V lance(# ) <br /> 31g,- q?7 - - 0 -S ❑ <br /> Re/Ian drawn to scale <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION an in dimensions <br /> AG T NAVE <br /> / 1 CONTRACTOR NAME <br /> P4. i/jp .-A-If Dcvtl /eou,/,ct` sf Site Plan including location <br /> GENT ADDRESS CONTRACTOR ADDRESS/ cif well/septic <br /> (City,State,Zip) (City,State,Zip) t Setbacks <br /> PHO"N (leis , w( S s'(1r u-e e�I / w1 S--3S 4/% ❑ <br /> / PHONE i a oval from <br /> gptJ- 4'50 -6•°0e go2e)-6$-0 -lo d4� ab township. <br /> E-MAIL ADDRESS . E-MAIL ADDRESS l i <br /> e a, n. i <br /> ITC- te/n PS k C vn, vie I . h c _ ,774,0I , cem Fjbor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wlus/) <br /> PARENT PARCEL NUMBER: CURRENT rSJINGACREAGE: IevatiOn of grope PARCEL ® /_ I /—'' '° J/° v frontage W ( ge draw scale. <br /> TO NSHIP: SECTI N: <br /> O /a: \ <br /> i ea s�.�1-S t�`n. /a�/4: ❑ Drivew permi <br /> ADDRESS: P Y (stat ,coun ,town) <br /> 02 Q 3(r -rig` `` ❑ Sa its permits <br /> CSM: Y LOT SU%DIVISION BLO K/LOT <br /> e r I sa. 4)•$'• '- _ <br /> (gib• ,private) <br /> PROPOSED PROJECT INFORMATION <br /> P JECT DESCRIPTION: <br /> ° IF�T� <br /> AI,: <br /> Ca P �n qN Q� _ y t $ to <br /> ❑This project is a new building or structure. :d i , <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U R6 s s <br /> y" <br /> SEWER nSEPTIC tj y# ` , <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not inc ing basement) <br /> f g etIan <br /> AREA TO NEAREST SQUARE FOOT: �� � � : <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 9G s s s € s "i. " <br /> 1ST FLOOR: b . <br /> TOTAL SQUARE FOOTAGE: j ,..,-..„(„d4, a. Y <br /> 1' <br /> : ; <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: / rw '4 s--tt> S <br /> (Please round to nearest dollar <br /> 1/ r ,/ % may" `� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? El Yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 'a Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes gNo ❑Don't know <br /> 7. Is this to correct a violation? E]Yes ®No <br /> -i('' .......s-- ti <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioa) 0 <br /> (Continue on Back) -► -► -► <br />