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9 t8 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME rr�� <br /> z q-q L.a (D Road U.-C. lazzining Stat s; CU <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restrl t ; CSM <br /> V3SS. 1;A1&,,.L‘..kv t 62,( •4Zoo Audi iSo%A kJt .S3Z << Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> ■ 0;–; 2- ( r a a Ieko. e...v• o tA4,A 141 111-so Plan aw scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include imensions <br /> AGENT NAME CONTRACTOR NAME <br /> 2a-v4o It P•Pat\1ex0. dkv Re `t RGS KIA SSav` Ite Plan' clu • location <br /> AGENT ADDRESS / CONTRACTOR ADDRESS of well/se ti <br /> 5aa.4-2 C.s o,b6a < -?-602- ?&vk c6ve e. <br /> (City,State,Zip) (City,State,Zip) et aC <br /> IUlCd4e1,44,#% Ws S/ C6 2_ <br /> PHONE PHONE '/'/ ite Plan pp •4J from <br /> 6 o 8 . L/ 7 - t,S 8 Z applicab h p. <br /> E-MAILADDRESS E-MAILADDRESS <br /> V 6 " 0.tie t 4 d S .C o't^'r Floor plan scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levat n property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: frontag drawn to scale. <br /> ElPARCEL <br /> NUMBER 0Ze' 0 610 • o?Z 700D-3 A <br /> TOWNSHIP: SECTION: 1 Driveway er <br /> D v. n N 1/4: 1/41/4: (state,co ,town) <br /> ADDRESS: n <br /> 2717 L-o. - 14 " �4a►cit -a rype ru Q I <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, •j ✓ <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> . „E`fhis project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMITUM,R:i '��T�/�MrZr <br /> EWEREPTI( q (�"�!(J`✓1\ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Z y � z. <br /> J AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> — Ss Q di i S T 1 S <br /> O *. 4, TOTAL SQUARE FOOTAGE: <br /> D FOR 3RD FLOOR: <br /> ESTIMATED CONSTRUZ kOST: <br /> (Please round to nearest dollar) ■ ♦ ♦ ♦ ♦ ♦ $ 469 0, OB 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des Etclo ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Oes a° Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? laes ao <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) QYes No ['Don't know <br /> 7. Is this to correct a violation? QYes [/flo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ <br /> 545-112(4/08) <br /> . 6 - 6C_ cue e <br />