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(N 4,) i ife 61. 'e8' <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFIGE USE ONLY <br /> OWNER NAME <br /> Xa V J\Aou .. q' <br /> zoo tg Ulstrtci <br /> OWNER ADDRESS (Noumber,Street,City,State,Zip) <br /> , g It Van d <br /> I I'eoutted„Use? <br /> PHONE t�� •-(7Z e E-MAIL ADDRESS EglioNappogoggisNER <br /> one. CG1'1co. Gorr► <br /> : rung aft;s,C�1P; <br /> AGENT INFORMATION CONTRACTOR INFORMATION deed Restriction CSM:•AGENT NAME C CONTRACTOR NAME Van pce'(# 3 ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> � Slte I'loit drawn to scale <br /> and includes dimerts(arts <br /> (City,State,Zip) (City,State,Zip) SF`es <br /> ❑iI' <br /> t Plarttnc n 10 on, <br /> PHONE PHONE tic vfwelfsep , <br /> 4 Lf roA a <br /> E-MAILADDRESS E-MAILADDRESS 0" e ack <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) y0 Site.Plan a proval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: 3 p <br /> ❑ PARCEL a6,Cb%etE? 175Ftf. <br /> NUMBER (7g 11 -3l'-F-�s(t "D ,�:;, <br /> TOWNSHIP: SECTION: ' 1 ' ® Etir 1 � ess E <br /> -o W i\ o f S(Am ?r 'r i.e., /• y /4/4. (r ewlexistin�) <br /> ADDRESS: -Z 4 1� V"Gt/n� ?L(ii'l �Y2 r'� i' '> 1/�i S .S7Q! <br /> Elopr.plans to sca <br /> CSM: LOT SUBDIVISION BLOCK/LOT s <br /> 1 Elevation ofprope , j <br /> PROPOSED PROJECT INFORMATION 1* ` frontage:dr"awn to scale' <br /> PROJECT DESCRIPTION: ll <br /> (=/0 1-6(-6(e✓) 56 ed fleititeoyfrohittii÷firamph <br /> ®This project is a new building or structure. (state county,town <br /> ❑This project is an addition/alteration to an existing building or structure. W <br /> SBltitarypemrnit <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (pUb11�pr<tta01' <br /> ❑SEWER PTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) © Wetlandf�loodplalri! <br /> Li Shoreler d (attachment) " <br /> AREA TO NEAREST SQUARE FOOT: - <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErostonCo ttrol permit <br /> BASEMENT: 1ST FLOOR: <br /> l I TOTAL SQUARE FOOTAGE: j 1sl0peS,uISI:t]r ance-, <br /> 2ND FLOOR: 3RD FLOOR: V ,illinCg/access) <br /> ❑ Review location Survey <br /> ESTIMATED CONSTRUCTION COST: /� d 0 Q and available options- <br /> (Please round to nearest dollar) .' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project? N Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ❑No <br /> 5. This project is associated with a rezone/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 4 No <br /> 36 <br /> 0 v e APPLICATION MUST BE SIGNED <br /> sas itz(1/08) b(r✓ (Continue on Back) -4. ♦ -4 <br />