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t <br /> SUPPLEMENT to Web-APP # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> b ' L\, ,cu1 I i v't eS L L- -- ❑ Zon ,. Sta i -;CUP'm CO <br /> 0q3 3 <br /> • ADDRESS Sa.. 0 , , ..) � " r ' • <br /> l e . 1 ►1 ' 1 ' 6 a 5., —) <br /> •ME PHONE CELL • EMAILADDRESS <br /> • .-- <br /> •$% • Zi3 0 site Plan dra to " <br /> ,v s <br /> AGENT INFORMATION ; CONTRACTOR INFORMATION and inductee � <br /> � ����i <br /> AL CONTRACTOR NAME ❑ Ud�location <br /> E NTADDRESS CONTRACTOR ADDRESS Of WelUSeptC .03E) (• <br /> coley.aI.I..ZIP) <br /> (0er.still,ZIP) ❑ Se . <br /> ❑ site •, 0a`0y <br /> , <br /> PHONE <br /> PHONE appl � <br /> E-MAILADDRESS E.MAK.ADDRESS ❑ Floor plits94dre <br /> PROPERTY LOCATION INFORMATION (http. accessdane.eo.danne wl ps ) ❑ ElevatiOn etrea ie. <br /> PARENT PARCELNWlER: CURRENT ZONING: frontage <br /> ❑ mace. <br /> �► __—_ 'h: '�'� (date, ')0 <br /> .. q; I r • e • ► i D • IP ❑ Senihry tom" . <br /> rte. •cam: <br /> II 'r7i SUSONISION (public,privets) )3 • <br /> A 70 . , • <br /> PROPOSED PROJECT INFORMATION <br /> ., = 12- - Q . .) i 1 <br /> . s! project is a new building or structure. <br /> SANITARY.., • • PERMIT MASER: /` / <br /> le .- ❑SEPTIC <br /> HEIGHT w FEET. c 1 MINDER OF STOREENN Including ImorINNI <br /> • <br /> AREA TO NEAREST SQUARE FOOT.above grade decks or porches) <br /> BAssmen <br /> l <br /> (Outside dimensions including Unfinished area,attactled . (�,.;� <br /> v V '(� urr)off (v�Ap TOTAL.OVARE FOOTAGE: j <br /> 2ND FLOOR: ' <br /> i • to .. <br /> (Please round gdol Cosy. -. -. -. ♦ ♦ -. <br /> 3 4- <br /> One �No v 't know <br /> 1. The property la or lake?within 300 feet of a stream or 1000 feet from a pond Oita ®'Flo v Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> 3. Have you talked with the tranship about your project and are they in agreement? Yes 0 No - <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?.. ❑Yes 61111fo <br /> 5. Is ..�. .with a rozonelCUP/variance 4'i'.t!Aa I# ..., b blank R noes) <br /> 7. Is this to correct a violation? <br /> ---- Tgtl Must BE tip <br />