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VaYI (it ,11.3 Go likt.i'S <br /> SUPPLEMENT to WebApp# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME dzoning V J.(12(d' a rl 0' ' E. L._ c Status;CUP; <br /> OWNER ass(Number.Strut,C stagy.E Restrictlon;CSM <br /> l ) 11 C - it) #3-e A L. U' F, ,I• i tat.,l 7.71- V lance(# ) <br /> H CELL PHONE E-MAIL ADDRESS <br /> f ) El . Plan drawn to scale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION Old it des dimensions <br /> AGENT CONTRACTOR NAME ' <br /> 4 e 5 -f V LI Site ' 1 including location <br /> AGENTADORESS CONTRACTOR ADDRESS c <br /> • <br /> (CRY.State.LP) (by,Stale.Zip) 0 Setbacks <br /> • <br /> PHONE PHONE • Q to Plan •.+ •val from <br /> / PP',•.,ddetownship. <br /> E-MAJLADORESS E-AUJLAODRESS f' <br /> Floor plans to scale <br /> PROPERTYI.00ATION INFORMATION :{hiipJlaccessdane.co.dane.vvi.usf) Bevation of property <br /> PARENT PARCEL NUA R: CURREN za� ACREASe frontage drawn le. <br /> TOWNSHIP: <br /> — - __.eac Tt <br /> -f -S L A � C1. �rmtts <br /> � _1- --- . . . (s , -- - <br /> county,for t? <br /> mita," .---,. <br /> 5f I ve4c be) _- , i tiggiISpemts . <br /> CSM: -.er SUBDIVISION eLOCKA.OT ��ate) • <br /> )94 guu_koIlo • 4l • <br /> PROPOSED PROJECT INFORMATION .{ ^ •1 <br /> PROJECT DESC IPTtOM: 5 - 1�� CO t1 )1 f 1.0 o{j) 1 <br /> • tl s project is a new building or structure. - <br /> D This project is en addition/alteration to en existing building or structure. <br /> _ SANITARY . + . __ f Mfl i `.: — <br /> t SEWER Q saaTtc 3-36 r$ c000 <br /> HEIGHT W FEET. D 1 t BER# T RI {Not Inducting bssemetu} <br /> • <br /> ri • TO NEAREST SQUARE F0'r <br /> (Outside dimensions including , hed area,attached garages , d above grade decks ar Pages) <br /> - , eon. <br /> 1 399 :_ ` �►►i 3QtOTALSQUAREIOOTAOE:4. <br /> >x � p 5 , D��R • 'p: 0 <br /> ESTIMATED CONSTRUCTION COST <br /> _� ,4- -� -e -�, f_ ff / <br /> (Please rain to nearest ctrlj L.Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?........... QYes t(No .0 Don't know <br /> 2. Is there a wetland or tioodplain on or near the property? Dyes ['No ❑Don't know <br /> O. Have you talked with the township about your project and are they in agreement? fires 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 6 years? &Yes 0 No <br /> S. is this project associated-with a rezone/CUP/valiance(petitionlappeal# ) (ive blank If none) <br /> 6. Is a location survey retied? (see reverse) L1fYes C/No Q Don't know <br /> 7. Is this to correct a violation? DYes ltd/No <br /> APPLICATION MUST BE SIGNED j5 -- /-/22. f \______ ___ (Continue on Sack} -+ —o. —;••s,s,�z t�►om� <br />