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ZONI I. PERMIT APPLICATION wwwcountyofdane.com SUPPLEMENT to Web App # <br /> PROPEF:TIT OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEft ^7 H-Orne J a e i2.i a i a Yl +..-L—c Zoning Status;CUP; —/ <br /> w �r J� rbL .(e u-R- '1 peed Restriction;CSM <br /> Valance(# ) <br /> Sr; et* It 1 Site Plan drawn to scale <br /> AGENT IN°ORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT��J M .,i14, A ftvt CONTRACTOR NAME Ai <br /> uding location <br /> AGENT • CONrR7lcroR ADDRESS / of <br /> • <br /> (CRY.8M•.•, Ply.slw,zl�) Setbacks 7040,24--0 <br /> PHONE PHONE 4 Plan approval from <br /> . Bpplr�iBtD,Nlehip: ��,�-- <br /> E-MAIL •if E MALADDRESs <br /> 01 25 Ai Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (htttp: acccenssldNa�ne.co.da712-,,P.n .wi..us ) �� Elevation�• <br /> •❑ • -`= 3_6/ 0 fJ 1 / " e drawn to scale. 4 <br /> VL7 1�: s• !l✓ 1h1/:$ k/ Driveway perm:1 <br /> (state.county,483:11� Al 0 La,L L e,y..12- Al SBA,,.,_.. <br /> • LOT SUBOIWSION BLOCKILOT . . (V le) <br /> ■ 0 • At , •ll`o) <br /> PROPOSED PROJECT INFORMATION <br /> Plealacr �. A — ' <br /> • 1 eFe-- 1.4,G3 C -(46 . <br /> . 0-61,, . , . is a new bulding or structure. tn/ I)V t) r e U e t✓ _ <br /> St"- <br /> ❑This - . is an addition/alteration to an ext building or structure. 1 <br /> _...11.. Prlc _PEWIT WERW 7 l-7 _ .. _Vt‘j_f. <br /> -- L' SEWER <br /> HEIGHT IN ✓l NUMBER OF STORIES: (Nat Y AM basins aq 1 <br /> irill <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside including unfinished area,attached garages and above grade decks or porches) ` <br /> 9ASEMFJn!oie a 1 503 t>sTFLOOR,+—J 4 TOTAL SQUARE FOOTAGE: 3 i ? I. <br /> 2ND a 4 j 33V °°R 3 al-5-9 <br /> EsnmA ,. ... _ -, . OOST <br /> - .. ► _iii. .i. -► $ 9,� J ( � ( s <br /> (Please . • to nearest dollar) l, <br /> 1. The • . ,. to within 300 test of a stream or 1000 feet from a pond or lake? QYss �,.�� ❑ <br /> Don't know <br /> 2. Is ' - - Aland or lloodplain on or near the property? ❑ YJ No ❑Don't know <br /> 3._Have . . Iced with the township about your project and are they in agreement? I Yes ❑D <br /> 4. Has, - , - . a zoning permit issued for this property In the past 5 years? ❑Yes Qo No <br /> 5. Is this .gt,, ~ associated with a rezone/CUP/vadance(petition/appeal U ewe) blankgnone) <br /> 6. Is a •.7 survey required? (see reverse) 0 Don't know <br /> 7. Is this , .-• • - a violation? ❑Yes 'No <br /> • <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Beck) —► -► -► <br /> s4s„s(4RS <br /> • <br />