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N. <br /> ZONING PERMIT APPLICATION www►. SUPPLEMENT to Web-APP # <br /> coilmtyofdane.can <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> °Vi"�ER NAME WO! Q.� ` n en€5 L-C,C_. ❑ Zoning Status,�( � Status;CUP; <br /> OWNER ••• _s Isar I . ' -.ZIP).f W/ Deed Restriction;CSM <br /> • a t . lq I . 1 ' 4 I/ i..t .4A 3 Variance(#______—) <br /> • `E CELL PHONE E-MAIL •RESS / <br /> Q ; . , DO ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and indudes dimensions <br /> CONTRACTOR NAME <br /> ATA-Nii7 AG At3o ye <br /> ❑ Site Plan including location <br /> ,ms s CONTRACTOR ADDRESS of welUseptic <br /> (City.Slate.Zip) (City,Slate,Zip) ❑ Setbacks <br /> PHONE PHONE • • ❑ Site Plan approval from <br /> • applicable township: <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:liaccessdane.co.dane.wi.usr) ❑ ElevationofproperiY <br /> PARENT PARCEL NUMBER: CURRENT ZONING: frontage drawn to Scale. <br /> El -a glo ao33i. �, �D <br /> TOWNSHIP: SECTION: p • ❑ Driveway permits <br /> W i k SCE e_ %: 1/411: (state,county,town) <br /> ADDRESS: • <br /> ' , LI J 7 <br /> S u+clA Namolci❑ Sanitary permits <br /> CSM: LOT A S SUED •N BLOCK/LOT private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �/ <br /> • [W his project is a new building or structure. <br /> SANITARY SERV C�F PERMIT NUMBER: 5 .3 or) <br /> ❑SEPTIC `l/ <br /> HEIGHT IN FEET. / NUMBER OF STORES/(Not including Cement) <br /> OIC AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT` I I Z ,sr FLOOf 3� j 4 4 TOTAL SQUARE FOOTAGE j <br /> 2ND FLOOR: 3RD FLOOR: I ° i44(y� <br /> U <br /> ESTIMATED(Please nwndtotonearest dole.)COST -4. ♦ ♦ ■ -+ -. $ A 5 <br /> 1. The.prop is,v'thiD 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes t No . J Don't know <br /> 2. Is there a v� ' d"a�rdfloodplain on or near the property? ❑No ❑Don't know <br /> ' agreement? l� <br /> 3. Have you talked with the township about your project and are they in g reement? Yes ❑■ • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ►% No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (ler blank if none) <br /> 6. Is a location survey required? (see reverse) UYes D to C3 Don. <br /> t know <br /> 7. Is this to correct a violation? ❑Yes LU'No <br /> 4 UtP' L O APPUCATION MUST BE SIGNED <br /> (Continue on Back) •'■ "► "'0). <br /> •4sos) <br />