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Dame (1, � Zc,-)Ai'o,J c 1--/- 9 I 0 <br /> SUPPLEMENT to FYetrApp tt <br /> ZONING PERMIT APPLICATION www,countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME + . <br /> -i t 2 CL i t t3• ' ' , Lt..(.. ❑Zoning Status;CUP; <br /> OWNER •• SS(Number, •et City,§1.1 ..21 Rest/lt on;GSM <br /> 01 it 1 V) I"'l-t I ! ,Iii La 5. °1/- Variance(# ) <br /> H CELL PHONE E-MALADDRESS S <br /> ir f c1 Q Site Plan drawn to scale <br /> AGENT INFORMATION i CONTRACTOR INFORMATION and indudes dimensions <br /> AGENT NAME • CO - •-NAME <br /> U ii9 A• 6 t'Y 0 Site Plan Including location . <br /> •' M-ADDRESS OfwellfseptlC <br /> 0 Setbacks <br /> 11111111M411111111111111a11111111111111111 <br /> PHONE PHONE 0 Site Plan approval from j <br /> applicable township: <br /> E-MAILADDRESS E-AWLADORESS <br /> 0 Floor lien to scale <br /> PROPERTY/LOCATION INFORMATION (hItp;llaccessdane.co.dane.wi.usi) 'Q Elevation of property <br /> • PARENT PARCEL NUMBER: CURRENT NG: ACREAGE: frontage drawn r to stele. <br /> TOWNSHIP: \-`- SECTION: �_. rlyeway permits <br /> - --_ .f-!`-�1�-j;a ---t i -#—� --1,4v •• ._._. _ 1/414....- (sate,00unty,town) <br /> 5 / , 111'Pir- ` t'�OQCL 0 Sanitary permits . • <br /> cst: (u.- 13 SU90NkSION BLOCWLQT ,private) <br /> GUci--o 110 <br /> PROPOSED PROJECT INFORMATION j <br /> NROJECTCESCAIPTION <br /> r <br /> j ,-- '� - 1 rid Co t-t' L ti�� 1 <br /> - kf Is project is a new building or structure. <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> iW SEWEP Q saPrsc p - 000 <br /> HT IN FEET 3 0 j + 1 SAB.•sr+x as: (Nat Ins+ue basr ' <br /> S <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porahe.$) <br /> :E R1' i$L''OOR: <br /> 7.. '�-= ‹Tt7TAL SOUARR FOOTMIE + . <br /> 6'FL90tI' 3RD FLOOR: ' <br /> (Please toneas nearest doll rrr)cosT• ,7- 2� <br /> 1. The property Is within 300 feet of a stream or 1000 feet from a pond or lake?........... UYes No •0 Don't know <br /> 2. Is there a wetland or itoodplain on or near the property? ()Yes L�No ❑Don't know <br /> S. Have you talked with the township about your project and are they in agreement? Dyes 0 N <br /> 4. Has there been a zoning permit issued for this property in the past S yew's? MYes Q No <br /> 5. Is this project associated-with a rezone/CUP/variance(petitioniappeal# ) (4ve blank if none) <br /> 8. Is a location survey required? (see reverse) O6Yes E3 No ❑Don't know <br /> 7. Is this to correct a violation? Ea Yes BIND <br /> APPLUCA110N MUST BE SIGNED <br /> (Continue on Back) -+ .+ .4. <br /> 646412(Uo4 <br />