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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> IZ A/V 'C)q L ?AJ Al �nr as Is S E(Z-Lb E 2. ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed 41 it C ors T' 'R 4 A O R L-'anon.)I t 7C .535'75 Variance e(#n'cti <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (201 8355-aall;■ _ , 6- " .y b<c*t.r 1.c. a C.. ` Y 3 of ❑Site Plan d le <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and ind �jmns <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site P nr rrg location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well <br /> (City,State,Zip) (City,State,Zip) ❑Set <br /> PHONE PHONE ❑Site Pla :•:VI; .. from <br /> applica•`�-t. 7 ip. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑Floor pla s scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: `lCURREMNINV ACREAGE: ❑Elevation of p arty <br /> El V?, V Oci —�(�\ -� 1 O—V lC •U frontage r to scale. <br /> TOWNSHIP: SECTI <br /> v (� , ,�4: � �%,�4: El Drivewa pe s <br /> ADDRESS: (state, n) <br /> CSM: 4-7 5 �OT SUBDIVISION BLOCK/LOT ❑`S- 'i - •erm' .\. j� <br /> (. • , • v ) i Vim/ -� <br /> -e gv ar".'''' a€s-.rr7 't C r <br /> PROPOSED PROJECT INFORMATION �¢� � 3'4 * ��vY�{V <br /> PROJECT DESCRIPTION: 1 1 1 40 i <br /> P65.7 IFCAI^\ E C3u-c.><. b-X.Nw X r1 '` } <br /> . his project is a new building or structure. . n V O 'V� <br /> S 3 S p A i, tt�_ <br /> This project is an addition/alteration to an existing building or structure. z �-�G I ,V u <br /> SANITARY SERVICE: PERMIT NUMBER: k <br /> EWER OPTIC , '` <br /> r�j <br /> HEIGHT IN FEE': NUMBER OF STORIES: (Not including basement) at <br /> Ilk JJh <br /> mo t` f:.i;!'1';:'.'}.71:,;-':. <br /> : ' <br /> AREA TO NEAREST SQUARE FOOT: �f� . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � , "; ' <br /> BASEMENT: 1ST FLOOR:t i x +� '. <br /> 4 TOTAL SQUARE FOOTAGE: "; 1 c <br /> 2ND FLOOR: 3RD FLOOR: j C)( I q �(� � ,�e„ G�„' <br /> INlT4ar�, '+ Zb t <br /> ESTIMATED CONSTRUCTION COST: 7-f M ;. <br /> (Please rouni to nearest dollar) ♦ ♦ ♦ ♦ ♦ .4 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ekes [ io ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Ego JDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es alo <br /> 5. Is this pro ect associated with a rezone/CUPNariance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locatitn survey required? (see reverse) [Yes gio ['Don't know <br /> 7. Is this to correct a violation? ❑Yes N Io <br /> APPUCATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />