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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com _ Z 3 f
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> TRvck .trop / ►� Zoning Status;CUP;
<br /> OWNER ADDRESS (Number.Street,C�c State,Zip) Deed Restriction;CSM ' ,'
<br /> s6 8 tt4'6& Rd• ,ttLBio/J w/ S35.3 y
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 608-g 'q- 9lMSJ 262-23?t'-OIr8 rat-,-„ lkth, , ' -Aset•( .COv, _all l Site Plan drawn to sw :
<br /> • . •RMATION I CONTRACTOR INFORMATION -•- • •- • 1 ensions
<br /> AGENT NAME r CONTRACTOR NAME — �,
<br /> C tkt( CROeVIA) Apr PA Srynf' 77v Sank() /4C. IN - - .. _
<br /> AGENT ADDRESS _ CONTRACTOR ADDRESS pQ r✓ • of well/septic
<br /> /221 VLI'1Tvt2E al v6 1221 -V&1T.'4 - ��
<br /> (City,State.Zip) (City,State,Zip) Setbacks
<br /> �71.46-f ouF, wt S_7'1 la `,9-- ltvi t , tAii f_i s-zfd
<br /> PHONE PHONE 0r2 'ite Plan approval from 4
<br /> bob �SY- 6 3 8' bo r- tr - b ":_,_.�. hi.. •
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> eCrvrl in e ',6 p -11.5-. cam 5 +,t" - Aged Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ,., '
<br /> PARENT PARCEL NUMBER: `IS CURRENT ZONING: < Elevation of property
<br /> ElPARCEL 05.12--21-i— ao -I &— Z frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> met 04 2?- 14: IJE- 1414: Str AID D " awaypermi
<br /> ADDRESS: ( ,COUnty 0
<br /> ,514 11i4-06E•4 Act . ! Sanita +_ faits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> _ (publ' ,private
<br /> PROPOSED PROJECT INFORMATION ;�°. x-�. l3: q ) v�(- G ...
<br /> PROJECT DESC2IPTION: : �_- ��
<br /> 341.5 x zs' x too` P y(oT SID: -• - I '�ir731tryter4t t
<br /> ❑This project is a new building or structure. ; 1� ,- '_: <,a�76�l lil ft'�la i
<br /> Z This project is an addition/alteration to an existing building or structure. -
<br /> SANrrARYSERVICE PERMIT NUMBER: .
<br /> IXSEWER SEPTIC =-.116 ).!t)i(ifiar�a '
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> 1 A .Aff i,tq 41 T�74IWti } :
<br /> AREA TO NEAREST SQUARE FOOT: E^} III 1.4� - -''ell�t 1e. 's.
<br /> -,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i 0 Pi5l f^�� � iI ,iiIll, _;
<br /> BASEMENT: 1ST FLOOR: (ISM e l f_,-.-_,.-..,,,,r,..-:--f � 41
<br /> 4 TOTAL SQUARE FOOTAGE: j ` , .,,, f , 3-
<br /> ,
<br /> r? ItIiIX f�W �? r
<br /> 2ND FLOOR: 3RD FLOOR: ----N Y
<br /> ESTIMATED CONSTRUCTION COST: i 'ilrr�i7e,iI ii;i t11i[lif _ .:
<br /> -tip -► -► ♦ ♦ ?,
<br /> (Please round to nearest dollar) $
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 Yes ❑No ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes END ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? DYes p No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? nYes ❑No
<br /> Li j2 //7 ( I ✓Ct I b V APPLICATION MUST BE SIGNED
<br /> /545-112(4e) O v 1�, Q I off / (Continue on Back) -I. -.► -►
<br /> IV] r, 0 e " 1 4,r 1,
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