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/Gt./Y I( liu LAA-.mot G CNl, f IS <br /> SUPPLEMENT to Web-APP O <br /> ZONING PERMIT APPLICATION www.cotintyofdane.coln <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> V e('L` 1 'd.r " I ' c.- Lz iL ing Status;CUP; <br /> OWNER AD S(Number, .ut City, te, Deed Restriction CSM <br /> D '7 0 I +~� Lt) i�-( .b t.. I L c "11 Variance(# ,) <br /> HI Mtfr O CELL PHONE E-MAIL"j 1cY� Site Plan drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> . '' 1 6 A 4.bb v c Site plan including location � BR. <br /> ADEN DOP.ESS CONTRACTOR ADDRESS of welllsep <br /> (City.Pits,ZIP) PRY ate.ZiP) 433 tt)acks <br /> PHONE PHONE • te Plan approval from /� <br /> . applicable township: <br /> f-� <br /> E-MAIL/DORM \ `EALAILADORESS Or plans to scale <br /> -F • at"C.■Q 6 v-e I'■4lavnhoM¢.S.Co".. . <br /> PROPERTYILOCATION INFORMATION (hilp:flaccessdane.co,sbne.wL.usl) evatianofproperty <br /> PAREffr PARCEL.NUMBER: CURRENT ZONING: ACREAGE: frontage drawn to scale. <br /> LL :q- 070: -o -aa84)-o 4 - 1 6 <br /> TOWNS}{: sECTIN .. F t <br /> '1-t - - - _ _.__% _: 1� t �, (statunty, <br /> ADDRESS: r 4 'n <br /> 7 ...07.---..---. .-z-4-7-4-7- �ut15et 1e�2� V�rl anite7Permits <br /> CSM: lic, • SUBDIVISION OLOCKA.OT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECTDESCRIPTION: y . <br /> � " L7 ,orIc rt,tL.t.(,-) i <br /> . <br /> . 1. Is project is a new building or structure. <br /> • <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> _ SANITARY �-.:117 1,."N;13::p — _ . . _ <br /> VSEWER 0 5ETIC 1 — a o 9 - 000 <br /> , <br /> HEIGHT in FEET , i Alt OF$TORIES: (Not Including basement) . <br /> .a(o'6 i' MZtRM a <br /> • <br /> AREA TO NEAREST SQUARE FOOL' <br /> (Outside dimensions Including unfinished area,attached garages and shove grade decks Cr parches): <br /> rs rio... 7‘ • • <br /> 151 16 ,I% 4.TOTAi.SOUAREFOoTAGE:''4. <br /> I 4°1 I .,Azr--1-7 .41 ....etone ji. 114;03/All <br /> ESTIMATED CONSTRUCTION COS) Briliar 0 0 0 <br /> (Please round to nearest dollar) -r - -s -} ' -', lJ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ..... D Yes No .0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? OYes I No 0 Don't know <br /> 3..Have you talked with the township about your project and are they in agreement? ,d es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past S years? tSlYes 0 No <br /> 5. Is this project associated-with a rezone/CUP/variance(petitionlappeaai#- ) :- -blank if none) <br /> 6. Is a location survey required? (see reverse) ...., '� 0.,/No 0 Don't know <br /> 7. Is this to correct a violation? . iR 'es Rid No <br /> APPuc'JIoH MUST BE SIGNED <br /> {Continue on Sack) -+ -o- -I` <br /> 545-112(4)0 3) <br /> 5 157• \56 <br />