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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVI
<br /> OWNER NAME
<br /> M
<br /> ���' h VAT jkitZoning Status; CUP; r , L��'
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) G
<br /> LQ T�(O� � Deed Restriction; CSM
<br /> Variance(# )
<br /> HOME PHOLUNaI-P E CELL V�PHONE 1'C� r E-MAIL ADDRESS
<br /> $�2' Oqa a- (pub 2o(O 15 -� 't✓t�toen •(YlO--t��(-GY ' ■ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME gC1.
<br /> t ∎IU ADD.\( O 5Vk( ,Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR RESS of vis4 iC
<br /> 5\3 POrfaClia VICI 0Setbacks ©Q 3 3
<br /> (City,State,Zip) (City,State,Zip)
<br /> 11 t PHONE ON�� + i ite Plan approval from
<br /> FO applicable township. ���—
<br /> lLC$_ 5-15_ -IN
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> vEm 011�1 C hk,�11�U ,CCYYI Floor plans to scale /
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.w. us/) Elevation of r0 e
<br /> PARENT t?7)?Y M CU RENT NING: AC G p p❑NUM ER � �,-/5/00-0 � �I frontage drawn to scale.
<br /> TOWNSHIP: SE yy,, S /,^ iJ�
<br /> ��� {SC( �v ,/.: ��^ ,/.,/.. Driveway permi._
<br /> state,coun , own)
<br /> ADDRESS: A ielv c jg Sanitary permits
<br /> CSM: LOT SUB SION ` K/LOT
<br /> /f rive 1c — ✓G , (public,> )
<br /> PROPOSED PROJECT INFORMATION
<br /> —1r-11— aitti
<br /> PROJECT DESCRIPTION:
<br /> ;
<br /> .1,,,,::: ,, f..,,,A.'4:::.',,,s; , ".., z
<br /> �i1 ;n ,-� Z 2 �C � >,�
<br /> . ❑This project is a new building or structure. /� �� C 'f" ti ' ;�
<br /> This project is an addition/alteration to an existing b Ilding or structure.
<br /> ,:=, W, :---:,-...:,.. ,*„... :,-.,, ' :
<br /> SANITARY SE VI PERMIT NUMBER: ,t-,,,,,401:4;;:-..1:-."'
<br /> EWER EPTIC - II�� r a
<br /> HEIGHT IN F T: ///'''���D NUMBER OF STORIES: (Not inGuding basement s,
<br /> „ 1�■ E !I. , ©mss
<br /> AREATO NEAREST SQUARE FOOT: ( "^
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,Iiialltry.4,1,4,7,Stio,_ , 95
<br /> BASEMENT: 1ST FLOOR:
<br /> 3
<br /> / TOTAL SQUARE FOOTAGE: ' ' y ' ° r f
<br /> �e r a } 1/
<br /> 2ND FLOOR: 3RD FLOOR: 3 / � 1[
<br /> ➢ ,°
<br /> t 1. I
<br /> ESTIMATED CONSTRUCTION COST: $ /2_ 00 6 0 , :4'
<br /> (Please round to nearest dollar) 1...," `-
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes al. ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Elves ❑No Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes Es)o
<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/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) Elves ENo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes �Jo
<br /> APPLICATIU BE SIGD
<br /> (Continue on ON Back)MST -► -►NE
<br /> 545112(4108)
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