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AI> 7 ' e SUPPLEMENT to Web-App # <br /> ZONING PBRIVIT APPLJCAIIOU wwwcourtyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C VOA j k SC h cc edi.°r <br /> Elloning Status; CUP; <br /> OWNER ADDRESS (Number,Street,C S te,Zip) Deed Restriction;CSM <br /> Variance(# ) <br /> HOM E__pON� 1 7 CELL PHONE E-MAIL ADDRESS <br /> f� � �7-1:2 777 <br /> ..Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Serc �ctt(peuoc i; t' i? <br /> V( -- ti V1 ' '101.6 s a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRE�S of well/septic <br /> t Li 6 ltl�c 6t" . <br /> (City,State,Zip) (City,State, ip) I 4; -744.1 <br /> tbacks <br /> yVl iselo . + <br /> PHONE PHONE �c A17 9 e Plan approval from/�/ A <br /> o2h� ` r � w 1" applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS .--" <br /> ,F-1 r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ele ion of property <br /> PARENT PARCEL NUMBER: CURRENT ACREAGE: p ro p y <br /> 0PARCEL o IVO I i f - 3341 '- ]Ia -5- Q_ I /'�J " (-( j ontage drawn to scale. <br /> NUMBER 1� <br /> TOWNSHIP: C '00 t SECTION:3 3 ^ 1 '� <br /> �4 Q C3. 33 '/4: 5 E ��4��4: )vl W +veway permits <br /> ADDRESS: (state, county,town)JVA-- <br /> 3x5,0 G w <br /> //, <br /> CSM: LOT SUBDIVISION BLOCK/LOT Lsa4tary permits +-- <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> � <br /> `°r,QP -- Sckr\e pry K. 1-4 -E.o4r cifironing District <br /> ❑This project is a new building or structure. <br /> I�PIfriitted Use <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ilSZt falAd• -ss <br /> FIEWER PEPTIC (new/e sting) <br /> HEIGHT IN FEET: I /1 NUMBER F S ORIES: (Not including basement) 5Arc-e h 4 - ) <br /> a� —63 i,5/10/$" e 1 d/Ffoodplainl(fit •DOHS <br /> f Shoreian (attachment) ' e <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area.a ched garages and above grade decks or porches) y�� _� <br /> BASEMENT: 1STFL00 tLJ'trosionCOntrol permit <br /> � O 1 TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, I <br /> I filling/access) // <br /> 2ND FLOOR: � : 0 re Pe& <br /> jv °� v, ❑ view Location Survey <br /> ESTIMATED CONSTRUCTION COST: available options. <br /> (Please round to nearest dollar) –I. -1./. ♦ ♦ –0. 3�/ C <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres EINo Jon't know <br /> 2. Is there a wetland or floodplain on or near the property? fJYes ao Jon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Ilo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) LJYes DVo LDon't know <br /> 7. Is this to correct a violation? QYes Iio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) –► –► — <br /> 545-112(4108) <br />