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SUPPLEMENT to Web-APP # <br /> ZONING PERMIT APPLICATION www.cotuityofdane.com <br /> PROPERTY OWNER INFORMATION CU • Urn)PROVO' <br /> 1--Vei----S &-lk GI _n 4n fY\ - I-- C-- . . <br /> Me 0 ( a csx a.zroi IUD (t?a 110 i t 3913 (e_.--•-- <br /> '' .. <br /> �"'� CELL PHONE E-MAIL <br /> 4061 I P' lit s` Sipe Plan drawn to gale <br /> GG ENT INFORMATION CONTRACTOR INFORMATION and . ` <br /> m i✓ 1 A-60 •Q CONTRACTOR NIAMa? 0 • •; location <br /> AGE.NTACORESS CONTRACTOR ADDRESS - e' <br /> (CITY.eIT .zq) (011.111 s.Z) <br /> • 12 Setbacks <br /> • <br /> from <br /> PHONE PHONE . . town0P=• <br /> • <br /> E.MAILAODRESS E•MALADDRESS ■ to scale <br /> PROPERTY;LOCATION INFORMATION (http: accessdane.co.dane.wi.us ) I: = _ .i,. OTOPertY <br /> PARENT NAM NURSER:C3 Fes. - 1 .�-6 , drawn„ • <br /> 14:1/4s\A) of <br /> Towles 0 1 1/0/.: tow) <br /> Mt LOT / t 51 . .A Li <br /> di PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: P — 4A <br /> • 'This project is a new binding or structure. <br /> SANITARY SERVICE PERMIrNUMI7--/ ly <br /> ❑SEWER `� .n,.,,q <br /> (HEIGHT W FEET 1 NUM SER OFSTOR• = (Mot <br /> AREA TO NEAREST SQUARE FOOT. a decks porches)dimensions including unfinished area,attached garages and above grad <br /> -I4 1sT FLOOR: t L MARE FOOTAGE j <br /> 2ND Flo 3RD FLOOR ■ <br /> ESTIMATED CONSTRUCTION COST -e, -. -+ -► -♦ -► $ / ) Y 00 <br /> (Please round to nearest doily) . <br /> .0 Don't know <br /> 1. The.property Is within 300 bet of a stream or 1000 fast from a pond or lake? OW 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes O No <br /> 3. Have you tilted with the tawnship about your project and are they in agreement? <br /> -�aND <br /> ' <br /> 4. Heathers been a zoning permit issued for this property in the past 5 years? • o,ba blank If none) <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#----j e)Don't know <br /> 6. Is a location survey required? (see reverse) 4❑e yes <br /> 7. Is this to cornett a violation? <br /> '/ Mp�ICATION tM!!i-r !E SIGNED <br /> -iti:3_30) 7 APPUCus on dealt) E IG <br />