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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME„...-- _ /�
<br /> �/t/e/' 6 S fl ) e , 2 ❑ Zoning St s;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> ,, / Deed striction; CSM
<br /> 33// . z)e////5 i�GeJ 4 G- ( /11 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 3 A ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGE 'TAME SON RACTOR NAME
<br /> jUe I,) 15S(‘,U C ;G''j !,t/ //L/ 4- /L ❑ Site Plan inc ding location
<br /> AGENT A DI25,,SS TRACTOR ADDRESS of well/s .c
<br /> (Cit, 7 oz,ee)/ ev6s r7i-
<br /> State,Zip _ ity,State,Zip) El Se acks
<br /> /P'9_.r)/56/1/ 6)/ 5,)/7
<br /> PHONE PHONE 1=1 Site Plan -p• rom
<br /> f/a • 431. 01761 p f . S 27- t9/ro applica• n ns ip.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS .
<br /> b u p_i t vie d es(,hs 6U/ kjec !wk. ', : 5 q i 116 ❑ Floor plans tir4Ze
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZO ING: ACREAGE: ❑ ElevatlOnOf operty
<br /> ❑ NUMBER 0.7 fr J°J 'o_b-y,‘ acr t 1 (, .-17)� frontage wn to scale.
<br /> TOWNSHIP: SECTION: ll
<br /> I'1 ( b lb L E_Tt� Ill �5 '/4: /U �= 1/41/4: S W ❑ (st te,co"urlty,town)
<br /> ADDRESS:(_D
<br /> 351t Gt)U 50 l�fl �b ❑ Sanita ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu private)
<br /> � �
<br /> PROPOSED PROJECT INFORMATION r STAFF lll�
<br /> PROJECT DESCRIPTI / fix z r"
<br /> A E (,c> x/S T2vC 770 Al of 3 eE b PDnA P�(1Lif- o�(E U nibrl
<br /> . This project is a new building or structure. U P Utz
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: 0 RuratAdd
<br /> .11� i VER EPTIC 13 -„<0/ 5- - 00 ,,, <_,L , s
<br /> s�-� JJJ"`���"` ii, ,
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) %
<br /> /'(it l6 )
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensio s including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR: . 6 e r. k
<br /> 77, 2-,L ` / /SI `7/ , 4, TOTAL SQUARE FOOTAGE: 4, ( ,1,,/,;--,..
<br /> • * *'
<br /> 2ND FLOOR: 3RD FLOOR: ° ." % ',
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) .- ♦ ♦ ♦ ♦ ♦ $q.3 0 / 0 O U ` ' :.,,
<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 alko ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ialo
<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 /> G�"v J l-1 ( V.. 1 (Continue on Back) ♦ —►545112(4/08) �j�
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