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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION Www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME- t &hi <br /> i(. L. <br /> WNERADDRESS (Ntinber,Street,C' ,State,Zip ^ _ ❑ Wing Status;CUP; <br /> Z-Z 0 "ii-44/€.4/L,g �ta&e_s 4/r ri e, w 1J f eed Restriction;CSM ) <br /> ariance # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> Oa'3341'ZI ' 6/01-ttLo -16 Z l 474 - & A�`�' C oAt 45tCPlan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> ❑Site a ncluding location <br /> AGENT ADD CONTRA6TOR A SS of ye ptic <br /> (City,State,Zip) (City,State,Zip) Wetbacks <br /> PHONE PHONE ❑Site, royal from <br /> appl' township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ���� <br /> L or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.usn El ti of property <br /> PARENT PARCEL NUMBER: CURREN ZONI G: ACREA <br /> ❑PARCEL ,1 14.310--.7��0—o 4 ',� fro drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION; <br /> p 1/: n <br /> 6 //Y/: ❑Drive permits <br /> l <br /> (stat , ounty,town) <br /> ADDRESS: <br /> � 6 IC^A I t✓ ❑San. -ry •-rmits <br /> CSM: L. SUB 1p/1 ON BLOCK/LOT <br /> , WA/k ' , (pub!' rivate) <br /> C <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DE RTIONA5: <br /> jc IP <br /> -li 0 A. 44 Ol/ <br /> e R )0 q <br /> . ❑This project is a new building or structure. / <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT DUMBER: <br /> EPTIC <br /> HEIGHT IN FEET: �A NUMBER IOF TORT S: Not i eluding basement) <br /> Vs <br /> AREA TO NEAREST SQUARE FOI T: <br /> (Outside dimensions including unfinished area,attached gatages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> Or ,, TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: <br /> III <br /> ESTIMATED CONSTRUCTION COST <br /> (Please round to nearest dollar) ♦ --g ♦ —► -Si _ <br /> V . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? TS'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes tZflo <br /> 5. Is this project associated with a rezone/CUP/variartice(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ao ❑Don't know <br /> 7. Is this to correct a violation? [Yes DVo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />