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SUPPLEMENT to weirApp# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> r <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V t(- C ..t a.i1 4 OVYh 1' -- LL•. Qizoping Status;CUP; <br /> OWNER D ss(Number,:.ear City, ate,Z&, t Deed Restriction;CSM <br /> ((r 'l rC 1 . 6 1 to 1,-14 .11 L' Q*.n c;. l• ariance(# ) ..N M CELL PHONE E-MAIL ADDRESS tn.((� o Rx; Li Site PPlan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION 'd indudes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 'y�,D S ' `' A El to Plan including location . <br /> AGENT CONTRACTOR ADDRESS welUseptic <br /> • / <br /> (City.elate,zip) (City,State,2Ip) Q Setbacks `-, -- <br /> f <br /> PHONE PHONE O fie Plan approval from <br /> $ppllc3b10 township: <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:I/accessdane.co.dane.wi.us/) 4i vation of property <br /> PARENT PARCEL NU ER: RRENTZO ACREAGE: $ outage drawn to scale. <br /> O <br /> VIZ Q ?o '.ao, 'J© •.-o . I 4etn)TOWNSH : 1 SE O • 1,: %IA:\ r AC J <br /> ADDRESS: • (�' - <br /> �YJ 9 A ' r ' .it. Sanitary permits c� <br /> CSM: LOT / SUBDIVISION BLOCKILOT (public,private) <br /> AA)c .[-(0110 <br /> PROPOSED PROJECT INFORMATION Co L <br /> PROJECT DESCRIPTION: ' r\ 1 . ,u C Y\ )Trut�.-1,6 -1 _. <br /> - 11 is project is a new building or structure. 1 ' ,..•... , ` <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SFRvr —-EEERMLr1JUMBE'' - <br /> - L1YSEWER CI SEPTIC i 3—,- ✓oj( '3 1 <br /> HEIGHT IN FEET` l NUMBER OF STORIES: (Nstincruding b(a--semmeM) <br /> 3 ) -- <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dim=•.,• ; in., Virg unfinished area,attached!= •-s and above grade decks or porches) <br /> • t8T .. , <br /> l � � _ ° [7/ ' 4 TOTAL SQUARE FOOTAGE: j, <br /> 2ND -•- • 9RD FLOOR: <br /> (Please round to nearest RUCTION ' a -•► -,• -► -► -► $ 5 L.4 C o <br /> 1. The property is within 900 feet of a stream or 1000 feet from a pond or lake? ❑Yes L37 No •0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? El Yes ( 'No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ( Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? t 1Yes ❑No <br /> 5. Is this project associated-with a rezone/CUP/variance(petition/appeal# ) (lelive blank if none) <br /> 6. is a location survey required? (see reverse) Yes ,❑_,/No ❑Don't know <br /> t!d <br /> 7. Is this to correct a violation? O Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) --1. -P -► <br /> 545.112(4/011) <br /> 4:I 5 ,3 q , Q.) S <br />