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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 , I/ <br /> 1Q 4 (��� oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Ci ,State,Zip) Deed Restriction; CSM <br /> _-2_>( zz (Al/tu& 1j2 "G --fr' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> AE 3-5,? 00 e Plan drawn to scale <br /> AGENT INFORMATION, CONTRACTOR INFORMATION ;T'. , , and includes dimensions <br /> AGENT NAME CONT CTOR NAME <br /> JUJU ;( c v/ c4A4,4 <br /> 1 c = CV'° ❑ Site P • luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ep • <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> ( 4/V D(S 6j S3-7v3 <br /> PHONE PHONE ❑ Site Pla royal from <br /> Z3S,e3 & appli a ownship. <br /> E-MAIL ADDRESS � E-MAIL <br /> Stlet)- e Y 0r4,firdpvf,.ei pr� <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dani.wLus/), - s, evation of property <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAGE: <br /> ElPARCEL /_ U S ^� _6 1 frontage drawn to scale. <br /> NUMBER t��p O' <br /> TOWNSHIP: SECTI <br /> rU oUt'1ti ,/: <br /> -1/41/4: ❑ Drive ermits CMV <br /> ADDRESS: (St , coun ,town) 6 <br /> UcGle-_f�. 7 <br /> 2 /� anitary permits(.-)/ <br /> CSM: LOT SUBDIVISION 1 L BLOCK/LOT <br /> •rivate) <br /> PROPOSED PROJECT INFORMATION mss; TAEPREVI k-. <br /> PROJECT DESCRIPTION: _ a`� ° ti, Fix <br /> �G�C �7� 04(60 6-0a / Q L�, ( °Old e D ?,c a'� =A <br /> • ❑This project is a new building or structure. ''',4 P '®:1 <br /> G' ' project is an addition/alteration to an existing building or structure. k, M <br /> ,- <br /> ts ,-5-4 <br /> PERMIT NUMBER: , s iii r <br /> / A , f , <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) '' . - 1_70., �' <br /> 3C) r Z <br /> s�� 4oso® "``" <br /> ,t � <br /> AREA TO NEAREST SQUARE FOOT 5 - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �� F x <br /> BASEMENT 1ST FLOOR: ° `Q "1r`'$ <br /> 4, TOTAL SQUARE FOOTAGE: j, a- ° r - +"'- <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0 o Z-5(5 - L <br /> �t,e o , <br /> e <br /> ESTIMATED CONSTRUCTION COST : s M-4. ®a <br /> (Please round to nearest dollar) -► -► � � � $ -( O �QQv �`i-a`_ pe <br /> . <br /> aS <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 -❑'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes n-No Q� <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'es ❑No � <br /> ' D <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Eyes •EINo ❑Don't know <br /> 7. Is this to correct a violation? Eyes ,ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />