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0._ <br /> ,SUPPLEMENT to Web App;#. <br /> ZONING PERMIT APPLICATION www.countyofdane. o - <br /> PROPERTY,`OWNER INFORMATION ,; 2 , _ ,;'!"0-'.,"` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> MA3 t3 v p eE [ I Zonin S us; CUP; � dip <br /> O y RADDRESS J(Number,Street,City,St e,zip) q Deed striction. CS1111G <br /> 10 1 1 La-!.l _Si-0i T�f', S e/ Variance(# ) <br /> HOME PHONE CELL PHONE l E-MAIL ADDRESS - <br /> ' ', v6-.1;6a 7.4*/ '`- <br /> •'•� ❑Site Plan drawn to scale <br /> AGENT INFORMATION ^; . ,,,,e,; iCONTRACTORJNFORMATION !,; and includes dimensions <br /> AGENT NAME ('jair c 5/MI CONTRACTOR NAME/1 - <br /> 1-0/25�� IIC-' 4 ( c hT OWE 9E74.5 ❑ Site Plan irttiocation <br /> AGENT ADDRESS CONTRACTOR A DRESS of well/sep <br /> Sgt Lex�K31,� 54. 5 V30 Lex"161°K <br /> (ThSctate_Zip)a (City,State,Zip) 0 Sete6s <br /> 71/44' 8.3g....2 - 3 ``/o PHONE "• d I -Si ® ❑Site P n p 1 • - from <br /> / Q appli t, , ship. <br /> %MAIL ADDR S• E-MAIL ADDRESS <br /> k 1 eL owt-. 4,'.tz t)5 064 4 i kle-15,(c4i d <j n✓T . ❑ Floor plans ale <br /> `PROPERTY/LOCATION INFORMATIONi=(httpel/accessdane 1co.dane.vin.us/) _: ❑ Elevation of operty <br /> PARENT PARCEL NUMBER: CUR NT ONING: ACR fl°,2..E: <br /> ❑PARCEL ©s-12 ,.i IN—9t frontage Vwn to scale. <br /> I ' V <br /> TOWNSHIP: SECT <br /> R : <br /> - � ) '/a: 5E- '/4%: ❑ Driveway permits 1*... pe,r <br /> ADDRESS <br /> (state, county, town) <br /> �sn96 Ahe s rav1 Imo'. <br /> GSM: LOT t SUBDIVISION BLOCK/LOT ❑Sanitary permits(public, <br /> _ _lic, pnvate) need, <br /> PROPOSED PROJECT:INFORMATION - STAFF''REVIEW . _. : -01,16si\ <br /> PROJECT D. S IPTION: <br /> his project is a new building or structure. 0 per• ft Uses <br /> This project is an addition/alteration to an existing building or structure. r5 ,4, <br /> SANITARY SERVICE: PERMIT NUMBER: ���~ <br /> 0 RtJra�Address <br /> EWER EPTIC EXITTY 1/6 - ,95i i o 9 <br /> HEIGHT IN FEET ` NUMBER OF STORIES: (Not including basement) �,a {1,� 7 <br /> 0 / Wetlarn• Fl;r 9 e lain/ _ <br /> J S1lore 4d ' ac meet) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ' ,` �-� � <br /> ( 9 <br /> BASEMEN 1 ST FLOOR: ❑ rosionc-.ontrp per '�p <br /> ����^')� j TOTAL SQUARE FOOTAGE 4, '`' S�o}3▪eS-.StU ba1.1Cge 3 <br /> 2ND FLOOR: 3RD FLOOR: l - <br /> la Revie Loo Survey v <br /> ESTIMATED CONSTRUCTION COST 3 4 - �nd▪ -1ez7pfron <br /> Please round to nearest dollar '♦ ♦ '� ♦ "♦ / Fs lf <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? j es ❑No • ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? ! es ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? PA -s •No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des .p!1No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave • ank if none) <br /> 6. Is a location survey required? (see reverse) Eyes ,r1 • ['Don't know <br /> 7. Is this to correct a violation? Des );No <br /> • <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► .9 <br /> 54$-112-(4/O8) . <br /> • <br />