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• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.cotonyofdane.can <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ovvNER � b S l_-C- <br /> I 0 Zoning Status;CUP; <br /> V7377REssO�C%i�l,(�,L an Dew ;CSM <br /> Ivy . • di:car(47-2 <br /> Varian (#�--) <br /> HON <br /> CELLPHONE E-MMLADDRESS <br /> 1a1#+r._- 1111 0 Site Plascale <br /> Rein dravm to <br /> AGENT INFORMATION !CONTRACTOR INFORMATION <br /> and includes cmenslons <br /> AGENTNWIE CONTRACTOR NAME ❑ Site Platt including location_PIT CONTRACTOR ADDRESS of wei sept <br /> AGENTADDRESS _ <br /> (cKy.s+w.ZIa) <br /> Pill. ) 0 Setbacks . <br /> ❑ Site Plan approval from <br /> PHONE two applicable townenIP• <br /> E-MAILADDRESS S4MLADDRESS 0 Floor plans to scale <br /> PROPERTY;LOCATION INFORMATION (http: accessdane.co.dane.wi.usi) 0 Elevation ofproPen <br /> PMENT 0 PA PARCEL NUMBER: ZONING: ACREAGE: <br /> frontage drawn tD scale. <br /> TOWWBHE' . SECTION: — ate �0 <br /> J Q IA: 1/14: D , town) <br /> counlY <br /> q ' D W ! ' ❑ softly permits <br /> csM LOT SUED N ' • KIWI (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> r+ROJEOTDEIPTIDN: �� - N �n ...Iv.00 S <br /> . i LU''This project is a new building or structure. <br /> SANITARY PERMIT NUMBER: 3 87 <br /> SEWER ❑SEPTIC J/ <br /> HEI‘IT:aFEET2s 015--/. NUMBER OF STOR (Not k0 ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> above grade decks or porches) <br /> dimensions including Unfinished area,attached garages <br /> BASEMENT FLOOR:4 '`� TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: T, gj 3RD R OOR i G) -2, <br /> ESTIMATED CONSTRUCTION COST -► -► -► -♦ -► -► $ # ) 3 , 83 O• <br /> (Please round to nearest dollar) <br /> oyes 0 Don't know <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑� �o C3 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Ellfes <br /> Yes 0, • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? l blank if none) <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#,_.__ t ban <br /> __) No e) know <br /> 6. Is a location survey required? (see reverse) ClYes ( lo <br /> 7. Is this to correct a violation? <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Beek) •+ -∎ -lo <br /> , I <br />