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• <br /> r.SUPPLEMENT;�to�Weti�App = <br /> ZONING PERMIT APPLICATION www.countyofdane.com �.__._- ... _ = _ <br /> PROPERTY=OWNEICINFORMATION ?Aa,:,.0A :;i `-'} WMf-AVAt{c� s- CU OMER TO PROVIDE • <br /> OWNER NAM, <br /> / 7:6Z <br /> oning Status; CUP; <br /> OWNER AD. S (Number,Street,Ci ate,Zip) Deed Restriction; CSM— - <br /> A 4 .."SJ1_ / riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - <br /> i I I Site Plan drawn to scale <br /> 4AGENT=INFORMATI'OI!1,i„ < ; `' sr g (CONTit.ACTOR"INFOR IgT10ift a a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I]Ste Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> PHONE PHONE D Site PI approval from <br /> applic let ship. <br /> E-MAILADDRESS E-MAILADDRESS - <br /> D F o tans to scale <br /> PROPERTY/LOCATION IAIFOttM TION> (httpa/accessilane.co,dane3vuius/y ,, v _; Elevation of property <br /> Elfrontage drawn to scale. <br /> NUMBER CI 02 ^ 0- �L(aa, 1 - I�\' 6 _ <br /> TOWNSHIP: SECT1I N: , ' 1 , rIVeW ermlts <br /> O'//'y r ► — A: S W /4/4: <br /> (st , coup wn) <br /> ADDRESS: - <br /> 8y� Ci y ����t ❑San' permits <br /> CSM: ' LOT ' SUBDIVISION BLOCK/LOT_....s (• lic, private) <br /> PROPOSED PROJECT INFORMATION ST e Rf U =-�. <br /> PROJECT DESCRIPTION: Jo ^^11 q N� ,' •*•This project is a new building.or structure. a = =F 4.' ,�.�� <br /> ern-ilftd <br /> This project is an addition/ Iteration to an existing building or structure. p*- <br /> SANITARY SERVICE: PERMIT NUMBERC �� _ = - a <br /> k m. <br /> EWER EPTIC e� s e r .-_ <br /> - - - <br /> HEIGHT IN,:g-, , NUMBER OF STORIES: (Not including basement) c-' 4 -� - � ' <br /> �"` 1 ii:,e _ . .e 143 " -•,;-;, <br /> AREA TO NEAREST SQUARE FOOT to / <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - k* ° <br /> l p ]eS . eerrn t <br /> BASEMENT: 1ST FL <br /> 1 TOTAL SQUARE FOOTAGE: 4. 6° r10 <br /> 2ND FLOOR: 3RD FLOOR: -Wit if' °w '._ „z4 . � <br /> Far _ .•ESTIMATED CONSTRUCTION COST: e @ @ - <br /> (Please round to nearest dollar) �� ∎ „ —�` LT= g„yam ', c <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' IC 4o • a Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes o .DDon't know - <br /> 3. Have you talked with the township about your project and are they in agreement'? DYes No. - _ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es • <br /> . <br /> / <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) leave blank f one) <br /> 6. Is a location survey required? (see reverse) [Yes o ['Don't know <br /> 7. Is this to correct a violation? - DYes No <br /> • <br /> 6 . APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —4 <br /> so-mom) —7,,D , - <br />