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SUPPLEMENT to Web-Apo#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> ''•NiSt Kr, 001. 21.6Cti'j1 .•ti4 , ❑Zoning Status;CUP;
<br /> OWNER ADDR SS(Number,Street,City,Stale,Zip) Deed Restriction;CSM
<br /> G3 C7 et. rr4i-1VAa ',C ∎l6 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> '/ice 't' • lra . , . ' ■ l►, l'a'-- of*. ci Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and Includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 1( r_gel 446101rd 1`y,, (G F5MGYL ( . 1:11ge _ 1,1g, ❑Site Plan Including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> i7€ aPIPOPP 0 4 1 6 .-`7v4•' ' Z tf e-
<br /> (City,Stele,Zip) (City,State,Zip) ' ❑Setbacks
<br /> M A�(t ►.) t c)t,9GV Ni v\ Fli'0 3 \4\ t 3 -ti
<br /> P cks I PHONE t r , ❑Site Plan approval from
<br /> ••••■;, 621„1160 (,c3 12,t).8. -A115 applicable township.
<br /> E-MAIL A I DRESS E-MAIL ADDRESS
<br /> i.,. �r\(Oa,, . r • ANN*c ca�►1,. _ y,,,_ , r.. .a„dL•A,*(f,.,,, El Floor plans to scale
<br /> P ROPERTYILOCA:ION INFORMATION (http://accessdane.co.dane.wi.usf) ❑Elevation of property
<br /> ❑ UM
<br /> PARENT PARCEL NUMBER: CURRENTZONING ACREAGE:
<br /> NBER oB 10-MA'-01M •5 cl i✓ or M�Aa 2 rlto frontage drawn to scale,
<br /> TOWNSHIP: SECTION:
<br /> G.V Mme( Y�: ,�/.: ❑Driveway permits
<br /> 1 (state,county,town)
<br /> ADDRESS:
<br /> ._I!/S etei owae,. ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION 1CKA.OT
<br /> GI 4 (public,private)
<br /> PROPOSED PROJECT INFORMATION r( i a F
<br /> PROJECT DES('RIPTION: yy I- '''i ,' (rJa 2 3 ` t ', t.
<br /> 00 n S'll(/t C 'i d l\ Cr ~ si,i¢ a�b�'P r`V,);r i t ,4
<br /> This project is a new building or structure. F � i'l(. I i t)( �1 s ��'":
<br /> This project Is an addition/alteration to an existing building or structure. r!$I nj `
<br /> ,l c r,l'
<br /> '" zs
<br /> `''
<br /> SANITARY SERVICE: PERMIT NUMBER: r r3 I C I N t y;
<br /> REWER )EPTIC �i r �i4 lx r :M
<br /> Q;? -,4,f t,r ) 1
<br /> "i ` ia ' ( n$ 1'r' t HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) ,,tt i s } t
<br /> AREATO NEAREST SQUARE FOOT: 1` 2 ''', ' rff� -iTI r d 1,t4,rry(,�;;s
<br /> (Outside dimensions including unfinished area attached garages and abode grade decks or porches) ;' wstr ,?` �,:i a :.r ,
<br /> BASEMENT 1ST FLOOR: i ,-1 I",-i!''''r�� )p�� 1 3AI1)non
<br /> N©4e. �/,,./��, ,� TOTAL SQUARE FOOTAGE: j t a+iii,.i-,tl l�lil1 , ri`t
<br /> G// l �/"1 r o ,,,p 1, 4 r_vs ,'�'
<br /> 2ND FLOOR: 3RD FLOOR a J ._of,, 4.-p r��"' ,4,iA�x '
<br /> 1
<br /> ESTIMATED CONSTRUCTION COST: Q �x
<br /> (Please round to nearest dollar) '� '� '� '� .P : 't„I e.'' e , .(_.,;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes glNo ODon't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 o ❑Don't know
<br /> 3, Have you talked with the township about your project and are they in agreement? Yes ►rf o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes jilNo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal It ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) Des /ir o ❑Don't know
<br /> 7. Is this to correct a violation? OYes !ijNo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continuo on Back) —1. —i• —►
<br /> 545112(4/08)
<br /> xl /415
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