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t ay <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> • <br /> PROPERTY OWNER INFORMATION Cu TOMER To PROVIDE <br /> OWNER NAME / ' ` , • <br /> e • I(121/1 1}''>°s �G lr Zo g Status;CUP; <br /> OWNER (Number, >,steer, ip, 0 Restriction;CSM <br /> (� 1 - 57/6)00 p)' ��� N 3 dance(#_ ) <br /> HOME.t� CELL PHONE E.MAILADDRESS <br /> G. •i • • Site Plan drawn to scale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION and indudes dimen s <br /> AG E CONTRACTOR NAME <br /> "� <br /> i, 'bV J�• va ❑ S Plan i acing location <br /> 'AG • ..RESS CONTRACTOR ADDRESS We Plic <br /> (City.saca.np) (City.Sum.zip) Setbacks . <br /> PHONE PHONE • • ❑ S Plan ap vel from <br /> ship: <br /> E-MAILAOORESS E-MAILADDRESS oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/;acces^sdda°ne.co.dane.wi.usl) levation of property <br /> PARENT PARCEL o 9/0 a c�3'a���� mil.\ ACREAGE:W .frontage drawn to <br /> N ELR 0 <br /> TOWNSH�� n SEC •N %: V\/ ���/: ❑.0 ermits <br /> to <br /> y�V C7r ,county,town) • <br /> C o 3 ..er-)vyy\ Q. _ Sanitary permits <br /> CSM: LOT v SUBD�ON d �� r-%•1",.1 c ` / (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> pROJECTDEBCRIPTION: r <br /> ` �// <br /> D r 1 <br /> . 0 This project is a new building or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARYSE� PERMRNUMB Lf I Li <br /> ❑SEPTIC <br /> HEIGHT IN FEET. 51 • NUMBER OF S (Not Indudlnp basement) <br /> • <br /> • <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including Unfinished area,attached garages above grade decks or porches) <br /> 13�� i ✓`Y 1ST� '66 <br /> TOTAL SQUARE FOOTAGE: j <br /> s . 5 3RD FLOOR: $I <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ,♦ ,♦ ♦ ♦ ¢ • <br /> (Please round to nearest doper) w i� ,,.,,� <br /> 1. The.property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes CEff 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yqs 1141'o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes 0.ua <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes No <br /> 5. Is this project associated with a rezone/CUPNariance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ces ❑�N3o 13 Don't know <br /> [ <br /> 7. Is this to correct a violation? ❑Yes l o <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —+ <br /> Num <br />