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SUPPLEMENT to WebApp#. <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER:INFORMATION _ . ' ,' '3 OFFICE, USE ONLY, <br /> OWNER NAM <br /> j(*A Vt ti..3 W-t()N-1`S t - l.( C •❑ Zoriing District <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Oil° C_kft(\t'S 1—^ -ou6+-'roA . wi S3Ss`3 O PermlttedUse? <br /> PHONE E-MAIL ADDRESS <br /> y -' <br /> t t ; CUP OOC— S--)-5— —)72S b ' gi�J }omeSAAfs0}-6 /o1 O ZoningStaus ,, <br /> AGENT INFORMATION : ,,`:<° , ..._ CONTRACTOR INFORMATION ! 4 5 Deed Restriction;`CSM . <br /> AGENT NAME CONTRACTOR NAME : Varlae <br /> (# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS :O SiteOlan drawn to Scale± : . <br /> 6loto eat ne.0 Pb <br /> and Includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> S vn Pt2te. V--'t • 5 9 C ❑ Slte Plannlncluding locate on:. <br /> PHONE G PHONE of well/septic <br /> t <br /> E-MAILADDRESS E-MAILADDRESS :CI Setbacksy <br /> r R <br /> -PROPERTY/LOCATIOWINFORMATION (http//aecessdane coaane VOLus/1' .''. : <O Site Plan approval from ' <br /> PARENT PARCEL NUMBER: ZONING: <br /> ACREAGE: l <br /> O PARCEL b O -a( .a- 90 ) -NUMBER a appllcabetownhp <br /> TOWNSHIP: <br /> SECTION: ^ORura1 Address <br /> t,4. �4,4. (new/exlstibg) p , <br /> ADDRESS: <br /> e t , , c <br /> t: n ��3� � `/ p ^ioorplastosc�1� x l <br /> CSM: <<I LA�OT��'3S L r S B� D�IVG ISII+ON To� , �Bt LOCK/LOT j � * ' x <br /> r <br /> ire s r--, n <br /> '16 <br /> • VI _ Elevation oof property <br /> •PROPOSED PROJECT INFORMATION_; i = F frontage drawn to scale <br /> PROJECT DESCRIPTION: `I 4 ^ (� ' t t 21 a;r.ii' a <br /> \\o' X 1�D� 1'iuh��e �i U(�►e I DI 1t Ao' ()Qc.lt- ■v1 / S S wIl+ S}p, s l„y'D.nveway perrn}5r <br /> (sta 6A6iirity,town <br /> . un-This project is a new building or structure. , I <br /> O This project is an addition/alteration to an existing building or structure. xL Saritarytpermhts <br /> PERMIT NUMBER: ) <br /> SANITARY SERVICE: (pul)IiC;�s(',i5/ate��'�"� <br /> EWER ❑SEPTIC , a Ez ” c: ra <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ::O W, tiapd/Fldod`plaln/ <br /> l S:ofelah;tl"'�attactiment);: <br /> AREA TO NEAREST SQUARE FOOT: w ` 1A i I -- <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) O.J=foslon�ontrol permit <br /> BASEMENT: 1ST FLOOR: (slo'pes tl sturbaJ ce, :, ` <br /> Dp� 4, TOTAL SQUARE FOOTAGE: j , 4 <br /> 1 filling/acgss) �;? <br /> 3RD FLOOR: '' � , �x 1 <br /> 2ND FLOOR: �� � �� �� '���' <br /> � <br /> � )0 J0 Review ocatlon Survey:, <br /> ESTIMATED CONSTRUCTION COST: $ I) DO© C3 v and avallabte option's <br /> (Please round to nearest dollar) _ a-.• <br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake? O Yes al-No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? Li Yes [ii-No O Don't know <br /> 3. Have you talked with the township about your project? 2-Yes O No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? O Yes No <br /> 5. This project is associated with.a rezone/CUP/variance (petition/appeal# ) <br /> (leave blank if none) <br /> 6. Is a location survey required? O Yes 1-No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes Ei-No <br /> Iw{, 14 ?? AC or0 75—= 127 <br /> APPLICATION MUST BE SIGNED <br /> / 6r° (Continue on Back) -+ --* -► <br />