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SUPPLEMENT to Wei•APP # <br /> ZONING PERMIT APPLICATION www.cotmtyofdane.can <br /> PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE• <br /> OWNER Wye_L` • al) ' 0 e c_L- c ❑ peg CUP; <br /> CSM <br /> OWNER�ooRss�ri.„d.. .ar .zp (3 <br /> Co , <br /> HO CELLPHONE E•MAILADD. ❑ Site Plan drawn 10 scale <br /> •• , , and indudes tensions <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION <br /> AGENT NAME � CONTRACTOR NAME ❑ Site Plan inducting location <br /> m c A(°fib V _ of well/septic <br /> AGENTMDRESS CONTRACTOR ADDRESS <br /> ❑ Setbacks <br /> (CRY.Silk MP) (ca ask,AO <br /> ❑ Site Plan approval from PHONE applicable tOwnshiP; <br /> E•MAILADDRESS E.MIAILADDR£SS ❑ Floor plans to scab <br /> PROPERTY LOCATION INFORMATION (http; a ccessdane.co.d3ne.wi.usi) ❑ Devotion ofpro r�. <br /> PAr T PARCEL NUMBER: CURRENTZDMNG.. ACREAGE frontage drawn <br /> E] FARea 0°116-243 -ISb2-e, 2-3 <br /> SECTIOl�t ❑ (state,county.town) <br /> TowNSHIP ) ' 20 y.; — 1/.'4: , <br /> ADORERS: <br /> 0`1 — b( sua,Lei 41 , ❑ sanitary is <br /> Mt SLOCKILOT (public,private) <br /> PROPOSED PROJECT INFORMATION t <br /> . ❑This project is a new building or structure. <br /> is .. . ....� _,- ..•:�; _ _ _ .. _ _ ., . .. . 7, •'.i �- <br /> SANITARY'S /IEWER PERMIT NUMBER 5 <br /> 13 `-`d f/O <br /> HEIGHT W FEET! NUUBER OF STORES: Mot ding bwm�� <br /> �Sf 1 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside di - • •,i •Unfinished area,attached garages and above grade dedcs or porches) <br /> ' 9 2� — j TOTAL SQUARE FOOTAGE 4 <br /> • ..ems 3RD- .OR: ri 6 c '°°1 <br /> 2ND FLOOR: L� <br /> ESTIMATED CONSTRUCTION COST: ,♦ -► -► -► ♦ -► 3 I �I ,00 <br /> (Please round to nearest dolor) At 3 SD.b 8 <br /> 0 Don't know <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?....••••• 0,s CI f C1 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> L❑�TN10 <br /> i 3. Have you talked with the township about your project and are they in agreement?•••• Oyes 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> with a rezone/CUP/variance(petition/appeal#___----) r blank if none) <br /> 5. Is this project associated ❑ , C3 Don't know <br /> 6. Is a location survey required? (see reverse) ❑Yas <br /> T. Is this to correct a violation? <br /> AppUCATION MUST BE SIGNED <br /> (Continue on Bade) "'• ♦ -4' <br /> i woe <br />