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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE
<br /> OWNER NAME 2
<br /> A!�/ _a�� S EI Zoning Status; CUP;
<br /> OWNER ADDRESS (Nurnbter,Stre t,City,State,Zip) eed Restriction; CSM
<br /> 72 51 per 1 1.e_ �cX dc,P)._v d"/ )1 3-3 S 3 Z_ ariance(# )
<br /> HOME PHONE , PHONE E-MAIL ADDRESS
<br /> /C0V'FY6-cs 2v (QOS-'HY OS-6 i • e Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and • cludes dimensions
<br /> AGENT NAME / CONT CTOR NAME , /
<br /> 3c,, ,✓! 5 P6,v /44,/ to Plan including location
<br /> AGENT ADDRL�SS CONTRACTOR ADORES ff well/septic
<br /> 725 r Pam t a rict va AKe
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> at,r r,e 5+ li:l 35.3
<br /> Si - Plan a oval from
<br /> PHONE Ur- �q _ 0 Sr/ ( PHONE E-MAIL DDRESS 5 7 _ 7 311 , ..lic township.
<br /> E-MAIL ADDRESS to
<br /> I Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1�, Elevation of property
<br /> PARENT PA EL NUMB _ RREN ONING:Ey ACREAGE: Y P P y
<br /> ❑ PARCEL O �© .��(= ,91‘51/0 7 ^r- 1 �0 frontage drawn to scale.
<br /> NUMBER / JJJJ ���jjj l
<br /> TOWNSHIP: SECTI rr
<br /> W,"n.d So( ( 1/4:J W ,/41/4 ❑ Drivewa rmits
<br /> ADDRESS: /� Q r (state ounty,t n)
<br /> L//4 Z U`n bvt'✓t 2J p�` d�e5i-j w ❑ S. ita ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT .ubli ,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: ' � �� ��� /
<br /> c778...... !- 0 -CI' \ ,A °. ^ ,,'° o iiy�District 01
<br /> This project is a new buildin or structure.
<br /> M , Plitt€ t
<br /> This project is an addition/ Iteration to an existing building or structure. , f� .ee
<br /> a,
<br /> SANITARY SERVICE: PERMIT NUMBER: Li Rules o e. `'x
<br /> f SEWER EPTIC IU L2asement) (new xistt •
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not in in El. 6�rtf. e �� IV
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) e, ., y. i .:tee "}. ,,
<br /> BASEMENT: 1ST FLOOR: 7
<br /> 7�^ 0 4, TOTAL SQUARE FOOTAGE: 4, * disturbance,
<br /> 2ND FLOOR: 3RD FLOOR: f (I\( O -;„ " eet
<br /> Su ey
<br /> ESTIMATED CONSTRUCTION COST: e it . ".ti=t. ,41„
<br /> ' �'
<br /> (Please round to nearest dollar) �V �GY To 0; ,,%.!;,;0-:. ,,,,,g,,
<br /> )
<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 M 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 ®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 1K1 No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ♦ ♦ ■
<br /> 545-112(4/08)
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