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— 7 1"- 01C . <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdanecom <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAIL ' <br /> V Q It:--1 c�i t r1 ov)11' LA_ 4 status;cup; <br /> OWNER •• r- -- la. + "heed Restrtdion;CSM <br /> N, I 01 • 7• �� P4 11 ! Ili o 1i 5^ // Variance(# ) <br /> He CELL PHONE E-AMLADDRESS <br /> 4 �-J i Ck�Plan drawn to scale <br /> AGENT INFORMATION ! CONTRACTOR INFORMATION and includes dimensions <br /> 5 A5 Mb V e NAME Site Plan including location . <br /> ,AGENT} ES S CONTRACTOR ADDRESS of well/septic <br /> (City.We.Zip) (Cay,Emts,no i Setbacks <br /> PHONE • PHONE • • ❑ Site-p!a I from <br /> a )e township; <br /> E-MAILADDRESS E.MIAILADDRESS ' <br /> p;floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:'accessdane.co.dane.Wi.usrI &Elevation of property <br /> WENT pA PARCEL NUMBER: CURRENT 20 ACREAGE:. frontage draWfl to scale. <br /> V TOW N51iF �04��Qtil1 SECTION: _ ` VP', its <br /> '/: 4/4/4_ ., town) <br /> ADDRESt ,,al - r <br /> -7 11 ' 1 , :fe _ 1 n S '4,.k <br /> CSM: LOT SUBDIVISION i prntate <br /> 169 d• :LUce_ 110 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION 5 rp, _ <br /> Ltd co nS-t-r�t�t�� � <br /> . [IYf hls project Is a new bolding or structure. <br /> 0 This project is an ad ion/alteration to an existing building or structure. <br /> . A Ewes D ssanc 60 a1 ' - <br /> HEIGHT IN FEET I - " NUMBER OF STORIES: (Nat indudIng bassment) <br /> AREA TO NEAREST SQUARE FOOT:. 'C4 2 <br /> (Outside dimensions Inchideg unfinished area,attached garages and above grade decks or porches) (� <br /> i luM Ni'- %g L:.'/ 1STFLOOIt ds7� i TOTAL SQUARE FOOTAGE: 4. N Q �0 1 <br /> 2N/D/FFLOOR/ 3RD FLOOR: j 1 Z i/ <br /> / g (# . /4011X-ESTIMATED CONSTRUCTION har COST• •• -► ♦ ♦ -♦ ♦ I $ 4. i , ()I�t� ,OD, <br /> (Please round to nearest "� V • <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ayes tNNo •❑Don' <br /> 2. Is there a wetland or tioodplain on or near the property? CI Yes fi(No ❑Don't know <br /> 3..Have you talked with the township about your project and are they in agreement? ISM es ❑No <br /> 4. Has there been a zoning permit Issued for this property in the past 5 years? *es <br /> ❑No <br /> 5. is this project associated-with a rezone/CUP/variance(petition/appeal# ) (1 blank If none) <br /> 6. Is a location survey required? (see reverse) &Yes 0 No 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes If0 No <br /> APPLICATION MUST BE SIGNED . <br /> • (Continue on Back) -s. -► -r <br /> 545.112(4101) <br />