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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 <br /> V e -- .i it n 0011 Lk-c qj zoning Status;CUP; <br /> OWNER DD {SS (Number,greet.City. a.�'..:)•• r Deed Restriction;CSM <br /> 1U 1 ` )\0:4-h ' 0-1 . , te— t1) (: -c . // Variance(#______— ) . <br /> H i6M 0- ,. CELL PHONE E-MAIL ADDRESS 11 <br /> � , �1 :Site Plan drawn to scale • <br /> AGENT INFORMATION i CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5 4 t> Obi e Eg Site Plan including location -AGENTADDRESS CONTRACTOR ADDRESS ofwell/septic <br /> ( .state.MP) Setbacks <br /> (City,State.Zip) / <br /> ❑ Site Plan appIoval from <br /> PHONE • PHONE • applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS boor plans to scale <br /> /• <br /> PROOPERTYILOCATION INFORMATION (http:flaccessdane.co.dane.wi.usl) ■ Elevation of property <br /> C:1 PARENT PARC??EL jJ ►E � �r �ENTZONt _ 1 ?ACREAGE: frontage drawn to scale. <br /> �. 1 <br /> TOWNSHIP: R EcTt rter . J C. I ❑.Driveway permits. <br /> i ∎).c\A A LI 'f<� '/'/4'. \'~' (state,county,town) <br /> / <br /> ADDRESS: L/C (_n ( � I ,\,s x CO L S ri Sanitary permits <br /> CSM: LOT 7'0 , ,SUBDNISION BLOCK/LOT (public,private) <br /> PROPOSE) PROJECT INFORMATION d <br /> PROJECT DESCRIPTION: ' ' '� t2�t11 �1 tz. L. 7 i <br /> • 5 - <br /> . m his project is a new building or structure. <br /> O This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 1 eERMrf_NU /) — <br /> ❑SEWER ❑SEPTIC 0' �, — v <br /> HEIGHT IN FEET .1___ NUMBER OF STORIES: (Not Including basement) • <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions includi •unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT ,13 '1ST_ L �� 4 TOTAL SQUARE FOOTAGE: ,,, <br /> "'ll // 7 � `/ i <br /> 2ND FLO : ----_ ` 3RD FLOOR: �I _�j <br /> esTt co T-Rtl TION COST: -+ -► -► -� -* -, P'') PO .. . . . .. - - <br /> (Please mun to nearest dollar) I I <br /> l�No Don't know <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes <br /> 2. Is there a wetland or floodplain on or near the property? CI Yes CdNo 4o ❑Don't know <br /> 3..Have you talked with the township about your project and are they in agreement? rii,5es ❑No <br /> Nas there been a zoning ermit issued for this property in the past 5 years? lyYes ❑No <br /> 4. 9 P <br /> 5. Is this project associatedwith a rezone/CUP/variance(petition/appeal# ) (1e9ve blank if none) <br /> 6. Is a location survey required? (see reverse) <br /> Yes ❑No 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Sack) –> –> _+ <br /> 615112(41Ctt) �) <br />