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SUPPLEMENT to Web-App a <br /> ZONING PERMIT APPLICATION www.courttyofdane.com <br /> • <br /> PROPERTY OWNER 1NPORMAT(ON CUSTOMER TO PROVIDE <br /> OWNER NAME ' <br /> V €.�•-i+t` 'LC 0 ' c- . Uzi_ t- ❑ Zoning s;CUP; <br /> OWNER ••-•SS(Number,=Oak Ci ts. D strictian;CSM <br /> ")Ci 1 0 i3.t .1)(I•i ilat :'rl1,t.c S`?- p 13 Vad ce(# ) <br /> H9 M13)d0 CELL PHONE E-MAIL ADDRESS <br /> t$� ���ii'�'j!["5 0 site Plan to scale <br /> and Inclu+ �di sions <br /> AGENT INFORMATION I CONTRACTOR INFORMATION <br /> NB IENE1 CONTRACTOR NAME <br /> 0 Site P n i Wing location . <br /> AGENT'DURESS CONTRACTOR ADDRESS of wei ptic <br /> lcttY.etc,rip) {cu);seta,zip) <br /> Setbacks <br /> PHONE PHONE 0 Sits i3 ', -it <br /> ' <br /> . app .:: (.i. shi,: <br /> E-MAIL ADDRESS E.MAILADDRESS r <br /> 0 Floor plan planpKcale <br /> PROPERTY/LOCATION INFORMATION (h11p:!)accessdane.co.dane.wi.usi) <br /> PARENT PARCEL NUMBER: .1-:• • 1." c: a-»r Q Elevation• pr. arty <br /> 0 PARCEL u 1 . frontage.6 , to scale. <br /> TOWNSHIP: sECTlON: j 1a <br /> A its <br /> _• rxte r <br /> - --- -t/Y1'-- ---,71 /:-.�... csta - >. ;R.1,:. n <br /> .- D 0 Sany <br /> �CSM: x-a� SUBDIVISION BLOCK/LOT/� 7 :o�' b 11 J _ .:;._.,.. <br /> PROPOSED PROJECT <br /> INFORMATION <br /> PROJECT UESCRIP'ON: , -51 - i fJ Co A)tTu t i;j <br /> I <br /> • m his project Is a new building or structure. -. <br /> O This project is an additionfaiteration to an existing building or structure. <br /> It,SEWER Q E&PTIc 3 .» ---0 0 e)a 7 <br /> HEIGHT 1N FEET: ?fi., I Idtl t( B� fi7 TORIES: (Not including bassrncrt) <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or parches), <br /> �STFCOOR Z r :, <br /> O •.-' 4 cTOTAL SQUARE POTASEr 4. <br /> D-FLOOFtf 3RD FLOOR: �f f� / <br /> • FTJ / p � <br /> 5 '�/ <br /> ESTIMATED CONSTRUCTION COST " ° .4. " `'$ 3 C e Cia OC <br /> (Please round to nears dollar) <br /> _ . _ . . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?........... °Yes I.eNo Cl Don't know <br /> 2. Is there a wetland or tloodpiain on or near the property? ❑Yes ('No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? des O No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? . llYes Quo <br /> 5. Is this project assoctated.with a rezone/CUP/variance(petition/appeal# ) ( ve blank If none) <br /> 6. Is a location survey required? (see reverse) ... YesC,��..,//No ❑Don't know <br /> 7. Is this to correct a violation? 0Yes llallo <br /> APPUCATiON MUST BE SIGNED <br /> tCorli nue on Back) -'r • 4 <br /> 545.112 NM) <br /> I <br />