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X03 , ( 0 <br /> 1 8 . 00 <br /> 533 " / C) SUPPLEMENT to Web-APP # <br /> ZONING PERMIT APPLICATION www.countyofdane.com 7 5 3 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> V e i-t.Ai( (1 D 'es i --(--- Zoning Status;CUP; <br /> l t Deed Restriction;CSM <br /> owNER�AOO ss (_ a )�6 N a . t GI AM P 3 HOME:. • CELL PHONE E-MAIL ,.- - ZAP <br /> in drawn to scale <br /> AGENT INFORMATION ! CONTRACTOR INFORMATION and udes dimensions <br /> 1 ,+ D <br /> j���i /4S �60 V`i blt ADDRESS � P ,� ding location <br /> AGENT ADDRESS <br /> (CRY,SIER.ZIP) (CM.1 MGM.IM) <br /> tires 1 .. . :I from <br /> PHONE PHONE . .'-,:`..township: <br /> E-MMLADDRESS E.MAILADDRESS p,'plans to scale <br /> PROPERTY LOCATION INFORMATION (http: a ccessdane.co.dane.wi.us ) TTT///��. -___e___�-�nofproper'Y <br /> PARENT PARCEL NUMBER CURRENT.. I ,: ACREAGE: drayyn 1D scale. <br /> 0 PARca, -9/0 . • / 'S 0 k.-_ COS• ' , <br /> / .6h Q %SW 1/41:ILO <br /> permits <br /> ci ( count%tow <br /> n) <br /> s ADDRESS: <br /> sM: q S CiA-a t Jtionm 441 I ION BLOCKILOT (public,�Itee) <br /> a I / eras <br /> PROPOSED PROJECT INFORMATION We IV <br /> PROJECT DESC rbN: S Ic ` N e s ,, ( /tit o <br /> . This project is a new building orFstructure. <br /> SANITARY SER -PERMrr ER: ,s .5 C s <br /> ❑SEPTIC !� <br /> HEIGHT IN FEET. NUMBER OF STORES: (Nd including <br /> V7AREA TO NEAREST FOOT: a decks or pordtes) <br /> (Outside dimensions including Unfinished area,attached es and above grad <br /> eASEMEN: 044)._ 1ST SQUARE FOOTAGE: <br /> 2ND FLOOR 3RD FL••-• g fi <br /> ESTIMATED CONSTRUCTION COST: �i <br /> (Please round to nearest dollar) '♦ ♦ -.► -∎ -0 <br /> _ 1 <br /> v Don't know P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? (❑_ v Don't know S <br /> in on or near the _'^ ❑No <br /> 2. Is there a wetland or floodplain property? <br /> 3. Have you talked with the township about your• • • and are they in agreement? Oyes 0, • <br /> 4. Has there been a zoning permit issued for this • •• rty WI the past 5 years? <br /> 5. Is this project associated with a rezone/CUP/vsrian•- (petition/appeal#_______.) =blank If none)CIO v know <br /> 6. Is a location survey required? (see reverse) ❑� � <br /> 7. Is this to correct a violation? <br /> APPLICATION MUS'r BE MONED <br /> (Continue on Sack) ♦ -P '♦ <br /> woo <br />