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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> (...7(52_50A_ )* A. it ' ,131 Zoning Status; CUP; , --/
<br /> OWNER ADDRESS (Number,Street, ity,State Zip) seed Restriction; CSM
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<br /> HOME PHONE CELL PHONE _ _ E-MAIL ADDRESS 1
<br /> / - g �■ t l!j Site Plan drawn to scale 1
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION • '. .- .'••_• - 50
<br /> AGENT NAME "rY
<br /> KQJ1f //� II CONTRACTOR NAME
<br /> 4(j TQoci-,0•J ,KQ61 Cr 603--1- Jc( Site PI.• luding location •
<br /> AGENT A RESS CONTRACVR ADDRESS 4111■.,-,
<br /> •f H/: -
<br /> ;Da(7 P'✓(°w I/,`et:J q 06(10 ou,��(�S1/; )�v .P Z
<br /> (C' ,State,Zip) 3 ��
<br /> (city state,zip) (� 9777 1 -1 Setbacks
<br /> PHONE PHONE 2 Site Plan approval from
<br /> c
<br /> 6 0 - 17I— 6✓`JC' &O S'- 7/ ?- (9 5? applicable township. ,/
<br /> E-MAIL ADDRESS 1
<br /> E-MAILADDRESS
<br /> - ( G<<)>Fa) L-,✓€'- CC)" 7 8 CO fro 571 co, i!fieo cosi , Floor plans to scale `
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ,
<br /> PARENT PACR�CEELNUMBER: I� URRENT/Z�ONING: ACREAGE: �I Elevation of property
<br /> ❑ NUMBER e/ !/ ^3Dl l�/� ,4, �, ?cs9 frontage drawn to scale.
<br /> TOWNSHIP: L ! SE_all O : ` A /F___
<br /> ��L(� C,-, V , : /V £ ,�%: A ❑ Driveway permits
<br /> ADDRESS: (� (state,county,town)
<br /> a 9 f CO !R-k,rJ� Ur .- _ -/e_ �� Sanita
<br /> n SUBDIVISION BLOCt�ILOT /
<br /> v.c ,ci ,'ems 4 '� �/� (public, v )
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPT V / /n/ _ /r\- • -e--e* d--10 4"4 '''' ,'44 / ,"1' if' ,, . , 4 ft,4
<br /> • ❑This project is a n .-.-1 •' g or structure. ��j� „ ,e,/ s �� %� U 4.11--„.._ ,g__
<br /> 0 This project is a, addition :Iteration to an existing building or structure. '�` i
<br /> SANITARY SERVICE: PERMIT NUMBER: t Ural ` ,(*a� ° „/
<br /> SEWER MEPTIC (new • 1P �'
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) y 'e
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) :1 ''ir, .
<br /> BASEMENT: 1ST FLOOR: 1 / �� fig F r
<br /> 36 // j TOTAL SQUARE FOOTAGE: ” + •—' , anti/
<br /> a
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 36_ ?'tom_ o�
<br /> tit � S
<br /> ESTIMATED CONSTRUCTION COST: Q� � O�' � ) 44,,
<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? ❑Yes Z No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? DYes _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 VI Don't know
<br /> 7. Is this to correct a violation? •Yes p No
<br /> c AP'LICATION MUST BE SIGNED
<br /> (C• tinue on Back) -►
<br /> 545-112(4/08)
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