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• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> L - p U Ill OY l . L L-C— ron�Status•CUP; <br /> owNF..R ADDRESS Muth's; City, / 09140_1_11-- /"�' <br /> 537(3 Deed Restriction;CSM <br /> • E s D■ CELL PHONE 61,0)Nit u�Q `W. Vadanoe(# ) <br /> i —3le0 & Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME VIA Q 1 <br /> A � Ask&ye X": - ' '7«. •ing location 1 V <br /> CONTRACTOR ADDRESS = <br /> i //(rer.Stalk ZIP) (CII.Stark ZIP) 1 Setbadrs 7 04 " <br /> PHONE PHONE • • %Site Plan approval from ,t/ <br /> applicable township: , /1 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> �, Floor plans to scale <br /> t I <br /> PROPERTY;lOCAT10N INFORMATION (http:',accessdane.co.dane.wi.us) <br /> rA PARENT PARCEL.NUMBER: CURRENT ZONING: ACREAGE: Elevation properly #*"-- <br /> El PARCEL ER frontage drawn to scale. <br /> NUMB <br /> TovvNSHIP: SECTION:INO:Li,0,40a1/4 <br /> 4'DdvewaguntplmAtl <br /> ADDRESS: R°4 5\ rhell <br /> CSM: LOT Gt � K`�'�� BLOCIrIWT ,• .-„� <br /> PROPOSED PROJECT INFORMATION <br /> • PROJEC cc k` 1112,0) •v\AiY'titAv ea <br /> • <br /> is project is a new building or structure. c F/ <br /> 0 This project is an addition/alteration to an existing building or structure. 14/M e J <br /> SANITARY SERIgwER 0 sonic OCO(,5= ©C )qoo Pv f- o <br /> HEIGHT IN FEET. -� j NUMBER OF ( Y l 1P <br /> I gr°' - /4L <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished are,attached�garages and above grade decks or porch.,)- <br /> 15 1 "U 1ST FLOOR, 6- :/kig' 4 TOTAL SQUARE FOOTAGE: 3 ef' <br /> 21E1 FLOOR: 3RD FLOOR: - '� <br /> l4 - <br /> i Td <br /> ESTIMATED CONSTRUCTION COST. ♦ ♦ ♦ ♦ ♦ ♦ <br /> (Please round to nearest dollar) ' App <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes Yilo ❑Don't know <br /> 3. Have you tacked with the township about your project and are they in agreement? ❑Yes 20 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) =blank if none) <br /> 6. Is a location survey required? (see reverse) 0 No 0 Don't know <br /> 7. Is this to correct a violation? Oyes Lo <br /> 5— 7 5- F 4-) . <br /> APPLICATION MUST SE SIGNED <br /> • <br /> 545-112 rwp (��on Back) -► -s. -0.1 Li gy , Oc <br />