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ti. 17
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> AOWNEJJR NAME n/ j 7../.2
<br /> st dr-1-+ '11/4�4,1,,e f �.. rd r../ J, t-'6 stir'G.
<br /> OWNER ADDRESS Wen r,Street,Ciiy,5 e,Zip) ❑Zoning Statu ,CUP;
<br /> 4./.4/4.1 �� r=c-c r .., fd�� `� 7�a--t v. l Deed s ction;CSM
<br /> HOME PHONE Variance #
<br /> _ CELL PHONE E-MAIL ADDRESS
<br /> '. g976,g c Y Y/7/O�z a. brie?. -i 'A,i1 t� /< «• Eu Site Plan�wr�,scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME
<br /> CONTRACTOR NAME
<br /> ❑Site pat ',- using location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS Of W I) !atl
<br /> (City,State,Zip) (City,State,Zip) ❑Setb
<br /> PHONE PHONE
<br /> Si Pla approval from
<br /> ap is le township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.d. , .' '/)
<br /> ❑PARENT /PARCEL/NUMBER: CU RENT ZONING: ACREAGE: LIZ" ation of property
<br /> NtYMBER rt y Q/7 ' ,J-pry / 11/4 frontage drawn to sca 1,140
<br /> TOWNSHIP: SECTION: 6
<br /> j 9 1 .1/4%,: �Drivewa permits e.' '
<br /> r a -2 l) i G+h/ -� ' ' (state,, .n i to •
<br /> A. / ,
<br /> / .fir .it"Lr -f . `/C1G> l 1/ " ',;,di h fl-4. g_.?f G ~ r
<br /> SM: OT SUBDIVISION BLOCK/LOT ❑Sanitary permits
<br /> (public,private) ho ic- /1�L
<br /> PROPOSED PROJECT INFORMATION . _ !
<br /> 1
<br /> PROJECT DESCRIPTION: �,A :44--t
<br /> � c�c/ - � 4c - ex•� b(J ,
<br /> • ®This project is a new building or structure. ',4 ,
<br /> -; t
<br /> ❑This project is an addition/alteration to an existing building or structure. -. t :" P
<br /> SANITARY SE V E: PERMIT NUMBER: 4 �4 f'.,'at.3 'e i
<br /> WER EPTIC 'It'; ' = q sf5 a '� `�
<br /> HEIGHT IN F NUMBER OF STORIES: (Nut including basement) tx` '
<br /> AREA TO NEAREST SQUARE FOOT: 1,',;,,I ' t, ab '
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) w :; ,. 1"
<br /> BASEMENT; 1ST FLOOR
<br /> / Zi j TOTAL SQUARE FOOTAGE: j
<br /> 2ND FLOOR:
<br /> 3RD FLOOR: , § � ":.;''',V,''.-1',-;,-,.:4:;:'-'f','„:1 ,`
<br /> ESTIMATED CONSTRUCTION COST: " ' � : 4 r-1—*(Please round to nearest dollar) -'i• ♦ "� -4. '♦ ``- !s
<br /> ■
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Yes o 0Don'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 ao
<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) ICS ►�►es al. INDon't know
<br /> 7. Is this to correct a violation? j♦ es alo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112 14108) (Continue on Back) -4. —I. -+
<br /> 4 N6 S'L(AA-16(/ `1 -QtN6 4-rA_Aele
<br /> I0 bc)c-oul-"' (v'lx\''-'i
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