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4-°1 7 17 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER► �7x c ,,r` /�!S '4 CUSTOMER TO PROVIDE <br /> OWNER ADDRESS Week MY)sob,ap) i <br /> 9'67 ES 'I. t•idr T/ At I-�iet(eX21.i wZ S 3..6.14 Deed ning Status;C( P; <br /> HOME PHONE CELL PHONE i �6d � Restriction;CM <br /> p 8 E-MAILADDRE88 (# ) <br /> AGENT INFORMATION xr,psi & ��71(10.44E''‘�reS <br /> CONTRACTOR INFORMATION Site Plan d to scale <br /> NAME CONTRACTOR NAME and includes dl en8i0n8 <br /> AGEN-..___.1 '► i, 0, �� 1 �1 ! <br /> ' ; I • ' Plan indudinfi location <br /> • • u V" <br /> i • • of II/septic <br /> (Gag .. L ... i <br /> it - 1• <br /> I I�ADOnESS• • ~ �/ ', / , A L'�Sfte Plan _ •. . <br /> Ifrom <br /> LADDRESS applicable hip. <br /> PROPERTY LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) , �� Plans oeale <br /> PARENT NUMBER:PARENT .❑ NU : CI-P= e` - - r� ) <br /> ., 07 c8--3d I-y/ S-p ievationof••.. ..rty <br /> a. <br /> TOINNSFIIR • °- - . - �le scale. <br /> f D/A1-01 BECTION: 3el <br /> 0 I IM (_ r. i-,county,town) <br /> GSM: • SUBDMSION BLOCK/LOT IL! <br /> enitery permits <br /> 14 s ail (public,private) �V '� <br /> PROPOSED PROJECT INFORMATION <br /> PROJEC r DESCRIPTION: �^ ^ . -i <br /> Zoning., ? ; <br /> . F:i is project is a new budding or structure. <br /> • is project is an addttion/alteration to an existing building or structure. ❑ P ° , rt.• <br /> PERMIT NUMBER <br /> HEIGHT IN •- - ►i:a- . /3 - r}®l8 - vp� 3 ` ❑ ,. _I ,A; <br /> FEET ) J N� °i ° x.. <br /> O5 , /' !NUMBER OF BTORIES: (Not n0 basement) <br /> J ❑ vvog .e 2 ° ; ,in/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> S !` merit) <br /> (Outside dimensions Including unfinished area,attached garages rid above grade decks or porches) <br /> 1sTFLOOR: �v ° <br /> 2ND FLOOR C) 3 L.3 4,TOTAL SQUARE FOOTAGE: j ( 'ev <br /> --- fiili <br /> 3RD FLOOR: <br /> T <br /> S96S <br /> ESTIMATED CONSTRUCTION COST: in .. t ''' ,.+ <br /> (Please round to nearest dollar) "► -► ♦ -� -► -� L,O JC ` <br /> O� a °,;A` 10 0 <br /> .-r,,,, <br /> =emu' <br /> 1. The property Is within 300 feet of a stream or 1000 feet from a pond or lake? Qy� <br /> 2. Is there a wetland or floodplain on or near the property? ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des <br /> e r o �on <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> 5. Is this project associated with a rezone/CUP/variance �� '�fo <br /> (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) r�-�,� <br /> 7. Is this to correct a violation? es So o ['Don't know <br /> [�eS <br /> 545-12(om) APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br />