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' SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION OFFIC: USE:ONLY <br /> OWNER�(AME r <br /> M� ✓t 1�l�( .1f1/ I `QA.V Q�O u Zoning District <br /> OWNER ADDRESS (N�u ber,Str t City,State,Zi .� <br /> -b �� \dy. , -Y nF� rmtttetf Use? <br /> PHINE E-MAILA DRESS 44 6CY-1 <br /> t �� s ' UP <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed RestnCtiont SM <br /> GENT NAME ONTF;ACTOR NAME <br /> ' .Ikt. . St �� V Ill / A . . .11 ) <br /> A N ADDRESS CONTRACT,' S �" <br /> j� ❑ Ite`Plall draWri,tO S ale. <br /> �L�►`� S`�` � 11044:64:160.1:9511 s dtri tersiorts <br /> (City,State,Zp) - ri State'Zip) <br /> �l 1 W` Sc_, f5q(p � � L\L Q 11( Q L Site Plan`i eluding location <br /> PHONE E -93—• � PHO �� f i �o z l S p is <br /> s <br /> E-MAIL ADDRESS <br /> MAILADDR SS €A A # setbacks t_A a: , ,k,,,,,H,!..",!:,;6:_::;,.,,,,,' <br /> PROPERTY/LOCATION i FORMATION (http://accessdane.co.dane.w .!s/) Site flan appro�al from, IA . <br /> PARENT PARCELNUMBER: ZONING: "� AC GE: appljcabC6tcxturtshlp <br /> ❑ NUMBER a u to -O �� c-:-�(` � ` <br /> /� ` / � Atia �:liura�Ad�ress 1 L L Wi�Al- c�/ — '/4: '/41/4•TOWNS ADDRESS: r� w/eXlsting) . <br /> CS LA LOT 1� —I� S BDIVISION �LH BLOCIiiCOf����� Fl nor plans to st ale <br /> Elevation ofprope <br /> PROPOSED PROJECT INFORMATION frontages drawn to sole <br /> PROJ T DESCRIPTION: <br /> �r p��aj'YU�n YL --� © Drtveway permit"s <br /> This project is a new building or structure. (states,county,fawn) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ❑ Santtarypermits <br /> SANITARY SERVICE: PERMIT NUMBER: (publi nvate <br /> ❑SEWER ❑SEPTIC �: <br /> HEIGHT IN FEET: . NUMBER OF STORIES: (Not including basement) Wetland/Floodplaln/ <br /> Shareland (attachmen ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ Eros(onGontrol perrn� <br /> BASEMENT: 1ST FLOOR: �1 {SIQ a -IIStC♦±�]af , <br /> 4, TOTAL SQUARE FOOTAGE: ♦ 1,. P s, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> in' <br /> Review�Location.Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -•► ♦ ♦ ♦ ♦ and avatla le 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 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes V. No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jo <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave bl k if none) <br /> 6. Is a location survey required? ❑Yes No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes o <br /> T B <br /> (Continue APPLICATION on Back)MUS =+E —SIGNED► �0 <br /> 545-112(vos) <br />