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301 <br /> SUPPLEMENT to W AIN ob-keY- <br /> ApP# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME ��Y <br /> G t2 L: R. - P L-E E w D ct <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 3503 wt� �c.t�� W ( • Suf, PRINK-IE ' Wt, a35°IO � ) e <br /> PHONE E-MAIL ADDRESS ak ,,.,. _P, <br /> 1, X05, $31- 1IC'Z <br /> AGENT INFORMATION CONTRACTOR INFORMATION irT , <br /> AGENT NAME CONTRACTOR NAMEe'�tfanCe <br /> 1v1 rt.%Wo 1 sIG0tJ SN� - RSA L�I.G' l <br /> !A ENT ADDRESS CONTRACTOR ADDRESS A04,6- �, <br /> 1. ' A tat>drawn c sat <br /> 320"1 G�LGt trrolu� 011 <br /> (City,State,Zip) (City,State,Zip) <br /> tJ i Wt 535,2.. <br /> I�l l d D l.rE(b <br /> It?t'i3 + tudt� lccaticrrr <br /> PHONE PHONE i <br /> •loD$. CoF�2-�I,o�10 X-3 I <br /> 1.47 a8, 662_°lo°l O of wetttseptic <br /> E-MAILA DRESS E-MAIL ADDRESS lbacks <br /> � g1•tr1S�e1 °GoM• <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi.us/) a •I t <br /> PARENT PARCE}NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL 012/o' it-101 <br /> ���, O �r , I.D� ` i WftS Mr <br /> NUMBER 1 <br /> T ANS HIP ry G� SECTinni• l f3-4ar f SS <br /> l �f"1./ 30 ��4: Ir� ��4��4: 1�1� <br /> A DRESS: a <br /> L-�Rp JcM ESN CLR�LS <br /> CSM: LOT SUBDIVISION BLOCK/LOT i oEar <br /> ^ 1 <br /> 4 tuytt I �--4 <br /> PROPOSED PROJECT INFORMATION � Btltff pro . <br /> frontage drawn to state. <br /> PROJECT DESCRIPTION: <br /> ❑ 'i ,= permits <br /> This project is a new building or structure. , �•(! �t ±r1 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Sanitaty permits <br /> �,�/ 82.33 (pubs►c,private) <br /> ❑SEWER !L]`SEPTIC <br /> HEIGHT IN FEET: i NUMBER OF STORIES: (Not including basement) <br /> I`0'`� D E t �t# odpEtl <br /> oretand (attac ment1 <br /> EAREST SQUARE FOOT: a <br /> 4:P <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) tt'©t e,rnilt <br /> BASEMENT: t ST FLOOR: f <br /> �!� p <br /> 2 t�'.D -?1.2 t + TOTAL SQUARE FOOTAGE: j P S: tS1 0 :` <br /> t filling/access) <br /> 2ND FLOOR: 3RD FLOOR: O' 5 <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q l d available piy(jbng, <br /> (Please round to nearest dollar) �1Q i2.2 <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. There is a wetland or floodplain on or near the property? ❑Yes Flo JDon't know <br /> 3. Have you talked with the township about your project? t'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑yes <br /> 5. This project is associated with arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No Don't know <br /> 7. Is this correcting a violation? ❑Yes $No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(1/081 <br />