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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION .countyofdane.com PP <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME�'/` <br /> OWNERADDRESSaN mreyStreet City,State,Z0i ed 6 6,-1 IN Zoning Status; CUP; <br /> ( be ,`��� p) */� E Deed Restriction; CSM <br /> HOME PHONE L/L/L/ CELL PHO IIE e `E-MA ADDRESS"i ' 53.97-7 Varia I ce(# ) <br /> 7 Pf-I f4 y --! a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /iU'S1'/s 5rr.ery �v/Set 1 c Site Plan including location <br /> AGENT ADDRESS CONTRA OR ADDRESS of well/septic <br /> d -.5a-kl-rsr c% Levi; <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE pH Ltc/ hit C--3S.- -5— Ite Plan approval from <br /> -bletownshi .•Cot S?S' 119'1 app P <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r- i�, _S . M F •or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acressdane.co.dar.e.wi.us/) <br /> PARENT PA CEL NUMBER: CURRENT ZONING. ACREAGE: i1 Elevation of property <br /> ❑ NUMBER O/ ©9,^NCQ3 ������v 1 ( ' frontage drawn t cafe. <br /> TOWNSHIP: SECTIQN: - 0 <br /> V/.0 � '/4: 1/41/4:\SL ❑ Drivewa ermits <br /> ADDRESS: (state unt •wn) <br /> C if <br /> CSM: OT S BDIVI'•ION BLOCK/LOT ❑ S.nit. permits <br /> Q f� e 61 0 . is +rivate) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: i y <br /> a� 1 x Ne �c,l� , 5-I_r.,-s .4 d 1./- ,e.c , �' D i 44; may. <br /> • ❑This project is a new building or structure. <br /> f rI This project is an addition/alteration to an existin building or structu e. <br /> SANITARY VIC : PERMIT UMBER: <br /> SEWER nSEPTIC ) �' ° <br /> HEIGHT IN F NUMBE OF STORIES: (Not i luding basement) s ;I <br /> q / ®/�� ty W 4 8# <br /> AREATO NEAREST SQU RE FOOT: 6,7'-,- <br /> (Outside dimensions including unfinished area, attached g rages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: # � \� ' <br /> ,4, TOTAL SQUARE FOOTAGE: 4, .," 2 +, i€1, ' ,, <br /> i 2=P: it ' ' <br /> 2ND FLOOR: 3RD FLOOR: % , y <br /> r <br /> ESTIMATED CONSTRUCTION COST: ila� s� ` U <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ i ♦ $ 9000 S " R <br /> ,s, f <br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? ❑Yes [Slo ❑Don't kno N <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes No ['Don't kno <br /> 3. Have you talked with the township about your prof ct and are they in agreement? ['Yes No <br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? ❑Yes 'No <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 1,! o Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> t,.1 <br /> -4-1‘ -? Co , O APPLICATION MUST BE SIGNED <br /> / (Continue on Back) -0 ■ - <br /> 545-112(4/08) <br />