|
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> P'ey /1 4'1E6 /I 1' c Zoning Status; CUP; A �/
<br /> OWNERADRESS (Number,Street,City,Sate,Zip)
<br /> 30u `^ �/L Deed Restriction; CSM
<br /> �c(.I(►( t3 'c+,,+- Variance(# ) Q
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6 cc--4sg-i z.? ,j74 Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONT;NACTOR NAME
<br /> prv(r Gobs-,? , ., Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic r
<br /> ice« 36-,„e-h Ly Le, [
<br /> lY I Setbacks 3�/0 (0f 3g'
<br /> (City,State,Zip) (City,State,Zip)
<br /> PHONE PHONE Site Plan approval from
<br /> 6.9 f-z,z-zs� applicable township. A5://t
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> j Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ni Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONI G: ACREAGE: P P y
<br /> ❑ PARCEL 0 i 2-0'2'II- 363 _ c frontage drawn to scale. fi 4
<br /> NUMBER �`C1 7a
<br /> TOWNSHIP: 1 SECTION: t
<br /> &, .-7-0,/ 3 0 1/4: S w '/4%: /V r- Driveway perm _
<br /> ADDRESS: ` (state, coup ,, own)
<br /> 7G la..
<br /> CSM: LOT //� S DXIVISION� Sanitary per
<br /> �-- tU 00 SS (public, 412311
<br /> PROPOSED PROJECT INFORMATION ST ,
<br /> PROJECT DESCRIPTION: r /'' ,,
<br /> � In£,�DiStiict 4 -
<br /> / C l K ✓tc�N Tio N 7 . c
<br /> . ❑This project is a new building or structure. ; ' its Use's
<br /> T.This project is an addition/alteration to an existing building or structure. _ i. 10�
<br /> SANITARY SERVICE: PERMIT NUMBER: z,, raj ='; °, , x
<br /> SEWER SEPTIC ' !1,,.
<br /> HEIGHT IN FEET: NUMBER OF STORIES: of including basement) `
<br /> Shoret�>( . tit > '
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,"° 0 e , ;
<br /> of permit,
<br /> BASEMENT: 1ST FLOOR: /►� ` -,6 h Al
<br /> 4� / 6 4, TOTAL SQUARE FOOTAGE: 4, (, ,, , y � 3 ri ,,,
<br /> 2ND FLOOR: 3RD FLOOR: /
<br /> g Suzy A.:04._
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ ?-000‘ DO
<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 ®.No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes w 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 J No
<br /> 5. Is this project associated with a rezone/CU= anance pe 1 • :•seal# ) (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 /> * C 0 , Z._ . 9
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back)
<br /> 545-112(4/08)
<br />
|