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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> C7GtJ�,f..1 �voi-7.41 l34-,/'%/,= ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 3 7/,-/ /0/m/2 /,----".1-=Z /7/O Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ‘3 , 7 e --zi 3 4 4- Y 3,5? -z 'E 5 '6 o,-ke tii2,,ez-1. ---"--)-7 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> !.t/;'•7-/)1Aie- ' -772, -..7-t-,--- -/ L t L ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> rN/0O2-5.-c.v, 11J2 ,3 7
<br /> PHONE PHONE 10<9- 4/'1/ — S Y3 S ❑ Site Plan approval from
<br /> D g - _ _..?y-c,7i/ applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL UMBER _ (! CURRENTZONIN ACREAGE:
<br /> ❑ Elevation of property
<br /> ❑ NUMBER n7/04 ', /Y3- �� Ate" 2�� `� frontage drawn to scale.
<br /> TOWNSHIP:
<br /> g 2,Pi 1 ec,0 SECT tl r 1/:J w) 1/1/: v
<br /> ‘A.),..._, Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> ❑ Sanitary permits
<br /> CSM: /®� LOT C� SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION STAFF Vil
<br /> -
<br /> PROJECT DESCRIPTION: ,',,,L,,
<br /> /7OD�TGat/ Tv c✓/l?-uT %?#- L, /-1.?/G- oning District`"'"
<br /> . ❑This project is a new building or structure. t . Use? .qty;.
<br /> This project is an additio to an existing building or str ct re. y4,,z
<br /> SANITARY SERVICE: PERMIT NUMBER: ukiritAddrew, 4,
<br /> (SEWER SEPTIC %��' zd1 ` ew y,- " °
<br /> HEIGHT I NUMBER OF STORIES: (Not incl ing basement)
<br /> 0o y©g a tiv
<br /> G/ ho larl (atrOftnt)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) e
<br /> BASEMENT: 1ST FLOO permit
<br /> 1j / 6 / ' � fR ,l TOTAL SQUARE FOOTAGE: j " m°'1n• ' (Iwittli (iG{£
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> Z 13 Q Review S e
<br /> ESTIMATED CONSTRUCTION COST: f1i,.,,
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ .' C�� A, �_/
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IbJ No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes �N
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan f none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -1 -0 -♦
<br /> 545-112(4/08)
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