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.SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER.INFORMATION` ... , :'-'j !.' �'. , : .. ' GUST MER TO PROVIDE
<br /> OWNER NAME
<br /> L R\L t P 1 A q_u Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,Qty,State,Zip) ,.,,,fi�,nn
<br /> Iln IS Ne&WA`s D' tefotn-c v)\ 53 5 'A. Deed Restriction;CSM
<br /> Variance
<br /> (# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> � "" Ito— 'VD 3M41' OLD VI Wil\MEtti A Ck vk( EA" ite Plan drawn to scale
<br /> AGENT INFORMATION ;;: CONTRACTOR INFORMATION;;" , .• ,Y and includes dimensions
<br /> AGENT NAME CONTRACTOR CONTRACTOR NAME
<br /> & it ®'ES\tl IOC- n including location
<br /> Er0- Res �s� CONTRACTOR ` °' I/septic
<br /> ( ity,s Ito,,rp> (city,state,Zi� ��,(Z ` Ltbacks
<br /> �� � h!\ {J�J� tl Lam„
<br /> PHON PHONE v t4r: : 0m
<br /> ip:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> e t 10CA, % AM.. % CO r` r plans to scale
<br /> PROPERTY/LOCATION'INFORMATION.;(http:1/accessdane.co.dane.wi.usn e
<br /> vation of property
<br /> PARENT PARCEL NUMBER: Cu NTZONI G: ACREAGE: p p
<br /> Ell N MBER A r 0 g 1113^'q i4-gli90 II ,S rontage drawn to scale.
<br /> TOWNSHIP: 1,`a��A SECTI N:
<br /> UV `VV�SO� 14: 5 t; %1/4: Ic't Okay permits
<br /> 1�) ( county,town)
<br /> ADDRESS: V "°If � a ry permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ( lc,private)
<br /> ,1 ► it A I .
<br /> PROPOSED PROJECT INFORMATION . ,
<br /> PROJECT DESCRIPTION: � P (/ is i
<br /> 11 A,
<br /> This project is a new building or structure. _ k i ;_ ,,-
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: sB"i '`a`
<br /> VSEWER 0 SEPTIC _.,t °'
<br /> HEIGHT IN FEET'. n I es NUMBER OF�STORIES: (Not Including basement)
<br /> di F + i� .)1.pit ge
<br /> AR illn 'REST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and a decks or porches)
<br /> BASEMENT 1ST FLOOR: (,g' / cJ r�� t� € �
<br /> rain � � ..S �j TOTAL SQUARE FOOTAGE: 4, ,,'a €-'. ",:Y ,i =
<br /> 2ND FLOOR: 1 ^ 3RDTl19191t7�f./.{v o '
<br /> J1 6f J < ti 1, y,. 1 . < r,°
<br /> ESTIMATED CONSTRUCTION COST -+ --► -► —► —► ♦ $ ",30 0 0 by.— 3 ,,,,f,alj .,,Hr)K.::
<br /> (Please round to nearest dollar)
<br /> i
<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 5.1t No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes MNo
<br /> 1. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L, Jo
<br /> Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> Is a location survey required? (see reverse) ❑Yes N No ❑Don't know
<br /> S this to correct a violation? ❑Yes N'No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -* —■- —►
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