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ZONING PERMIT APPLICATION www.countyofdane.corn SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION
<br /> OWNER NAME CUSTOMER TO PROVIDE
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> X �� ' _ ❑Zoning Status; CUP;
<br /> HOME PHONE �,�) �� , Deed Restriction; CSM
<br /> CELL PHONE E-MAIL ADDRESS
<br /> Variance(# )
<br /> Gs?, a67 355 60s qiz. os4z. , oercoS --LS , c-vm,
<br /> AGENT INFORMATION CONTRACTOR INFORMATION ❑Site nclu drawn to son
<br /> AGENT NAME CONTRACTOR NAME and includes dimensions
<br /> AGENT ADDRESS loo ALL. (0/J6T`ucrlo/f 0 Site Plan including location
<br /> CONTRACTOR ADDRESS W /� of well/septic
<br /> (City,State,Zip) 1ii1 (-(AIDh) rcb
<br /> (City,State,Zip) ❑Setbacks
<br /> PHONE I-00( , W:i- 5355
<br /> PHONE ❑Site Plan approval from
<br /> E-MAILADDRESS Gob '2.12. 1/14- applicable township.
<br /> E-MAIL ADDRESS
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Floor plans to scale
<br /> DPARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: 0 Elevation of property
<br /> PARCEL
<br /> NUMBER 030G 0'2..2-lo 0 ( ^1 L(,- / /Ai > 0,4 / 4,x1 frontage drawn to scale.
<br /> TOWNSHIP: 1
<br /> SECTION
<br /> 7,J G C 1/6 r04/1>PIT 2 %/4. S kJ /4,/; A)0 0 Driveway permits
<br /> ADDRESS
<br /> A(1- I (,cJ,,,TY f Cep . S
<br /> (state, county,town)
<br /> CSM: LOT
<br /> SUBDIVISION BLOCK/LOT ❑Sanitary permits
<br /> (public, private)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: ,STAFF REVIEW '
<br /> , fA OY 44 l l i( vv1- , J1 LO r nl r ❑ Zntng District
<br /> Wt `3;,
<br /> • ©This project is a new building or structure.
<br /> , 0•.,
<br /> This project is an addition/alteration to an existing building or structure. C F ermtttar Use
<br /> SANITARY SERVICE:
<br /> EWER �� O PERMIT NUMBER: 0 Rural:Address Y i ;
<br /> HEIGHT IN FEET. L' 1 "" vcTK � (n0u3/existing)°
<br /> NUMBER OF STORIES: (Not including basement) ," i g
<br /> C 0, wetland/F(oodpiatn/
<br /> AREA TO NEAREST SQUARE FOOT: Sh©relap (attachment r
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) � � °"
<br /> BASEMENT 1ST FLOOR: 0 ErosionC rltr0) 17 7t
<br /> (� TOTAL SQUARE FOOTAGE. , S o es (fist[urbal ce
<br /> 2ND FLOOR: 3RD FLOOR: '
<br /> ' 4fii(Ing/access)„4,,,,,,,,,A,-y ,
<br /> ESTIMATED CONSTRUCTION COST: 0 Review ieOti
<br /> (ion Stilvey '
<br /> (Please round to nearest dollar) --► —► —► —► —► --► /0 3 / avc� and avatlable options
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake?
<br /> 2. Is there a wetland or floodplain on or near the property? QYes ®No QDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? .., [Yes QNo QDon't know
<br /> p y p � Y 9 []Yes QNo
<br /> 4. Has there been a zoning permit iss d for this property in the past 5 years? QYes ®No
<br /> 5. Is this project associated with rezone/ UP/variance(petition/appeal# /06�
<br /> 6. Is a location survey required? (see reverse)
<br /> 7. blank if none)
<br /> 7. is this to correct a violation? ®Yes ❑No QDon't know
<br /> QYes No
<br /> z00 , 00 lj(iSe
<br /> Z ( � APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) O 0 U 0 (Continue on Back) —► —► —I.
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