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,,-.'so ,, ..-1'lr - t go c S ------ - -J-- 1,, _e_A--, <br /> ZONI -G • T I 0 www.count ofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> Le` ÷Rnge_L a, ❑Zoning Status. P; <br /> OWNER ADDRESS (Number, eet,City, ate,Zip) ,, ''`` Deed R str ion; CSM <br /> Z1 C�.oun Ore(xa n W S �g Variance ) <br /> HOME PHONE C L PHONE E-MAIL ADDRE4sSS (�� <br /> !._/; �' C�('1 146 teth 1 • (ln't(er- Co ❑Site Plan dr wn cafe <br /> AGENT INFORMATION I CONTRAC i OR INFORMATION and includes mensions <br /> AGENT NAME TRACT R NAME <br /> ikSii n Z ftndt ( ❑Site Plan i clu ' g location <br /> AGENT ADDRESS ONTRACTOR ADDRESS of well/sept <br /> ci 20 Pa_u,r e. Ct S <br /> (City,State,Zip) (City,State,Zip) ❑Se b ks <br /> PHONE PHONE ec or,��J, J3 �� ❑Site Pl p ' <br /> �% -11 2_ 5338 applic t.l s p.om <br /> E-MAIL ADDRESS E-MAIL ADDRESS Floor plank” <br /> PROPERTY/LOCATION INFORMATION (http://accessda:10:.co.dane.wi.us/) ❑Elevation f operty <br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: <br /> ®PARCEL 050C/,.OQ3 ____� 'Q — 1 frontage drawn to s <br /> NUMBER �l//'',„JJI�i++''�I OO r <br /> TOWNSHIP: SECT ON: <br /> O rt9 0n l c�J 8 1/e: 5 1/41/4: Driv a <br /> ADDRESS: (sta e, nty,town) <br /> 2.-:-4 v' 17 _ ❑Sanit per Its 14 <br /> CSM; LOT S IVISION BLOCK/LOT (public, ate) r m <br /> PROPOSED PROJECT INFORMATION _ STAFF FF REV <br /> IEW <br /> PROCT N. F.-curl. <br /> ®13 ,13 'N w Q L L ❑ Zonin g s ct Oct' <br /> . This <br /> project is a new building or ructure. <br /> ❑ Pere i1 -.+rT <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> EWER EPTIC <br /> HEIGHT IN FEET f �A t1 NUMBER OF STORIES: (Not including basement) oc <br /> !«<1JJJ 2 ❑ Wetland/Jo'(a / <br /> AR 0 NEAREST SQUARE FOOT: Shorela ment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT /' 1ST FLOOR: _ z ❑ Eros'•n . • of permit <br /> G ` 0f ,l TOTAL SQUARE FOOTAGE: +, (SIO .' •,6 U •ance,• <br /> 2ND FLOOR: — � 3RD FLOOR: F J?/ fillip•/a► 'S') <br /> I L`�/ ❑ Review Location Sury <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $Q� and - -ilable opti <br /> (Please round to nearest dollar) �P a , �'� . /I <br /> WV <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo ❑Don't know <br /> . 2. Is there a wetland or floodplain on or near the property? ❑Peso ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? BYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EINo <br /> 5. Is this project associated with a rezone/CUP/variance(pe ition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) 'I ,, Nyes 'lo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [ Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* ■ -+ <br /> 545-112(4/08) <br /> Rt.+ , 1 to, 6 <br />