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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNK NAME
<br /> 1114..i ii') ./a 714 . ❑ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,9ty,State,Zip) ki„, z..Dz- Deed Res triction; CSM
<br /> ,S 9, / e l 1I v af� 7 ,5.3620 Variance(# )
<br /> HOME PHONE f CELL PHONE E-MAIL ADDRESS
<br /> 4zg'43a' 9356, 0..,,,,51>n rig/z 4531 h DImai/i4 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT ME / CONT TOR NAME //
<br /> On Ze4 `• e/ea./ ,6u,/,/,rs ec,,D_ ❑ Site Plan including location
<br /> AGENT ADDRESS A ` /)� CONTRACTOR DRESS of well/septic
<br /> "'X NS oia /7// Y 7. Po, 9f0o261D
<br /> (City,State,Zip) (City,statg,_Zip) G ❑ Setbacks
<br /> g0 ,s. rL ��O I � Poo» , z-,91
<br /> .5.35 7f
<br /> PHONE PHONE, ❑ Site Plan approval from
<br /> .v g- 7 7e-d a3 b�gr'S`/,�- 7De3
<br /> applicable township.
<br /> E-MAI�PDGD�ESS �C1eoi �L'!�d ' E-MAILpDDRES/m 1 J ��
<br /> (Cl //// �U__7��/O/Zea �</ec�� vf�u� �� ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property
<br /> PARENT❑ NUMBER PARCEL
<br /> 0 61�/b/ 7�dCJ? CUR� TZOI�ING: ACREAGE g
<br /> /!J // J% frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> Tai.-/el ci ..,.,✓i igOa,,)e • .1/4: /,x/4: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION 42 .STAFF REVIEW
<br /> PROJECT DESCRIPTION: / '
<br /> 1 9-)CO v.21���(t mac(MV1L Amp, U Zon ',Old't '
<br /> jf
<br /> . This project is a new building or structure. ?'
<br /> Pe tt u
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: '''t411.4 �
<br /> fSEWER SEPTIC (new/WASC/ng
<br /> HEIGHT IN FEET: //J //�� NUMBER OF STORIES: (Not including basement)
<br /> c of/V e, / :,5,.,,',, �a Af ,i of "
<br /> / 4
<br /> and , ,, meat)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR:
<br /> Eta amtlr0EI�
<br /> 36 x 70/ j TOTAL SQUARE FOOTAGE: , a - d�r
<br /> 2ND FLOOR: 3RD FLOOR: // ii'„. a f ` s
<br /> la Review ESTIMATED CONSTRUCTION COSReview ,-(
<br /> (Please round to nearest dollar) ♦ "♦ ♦ ♦ ♦ ♦ $ Y� 000 C "vr
<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? DYes ❑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 ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —►
<br /> 545-112(4/08)
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