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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWN NAME
<br /> wa rre.L 4 AAA L b5 ' ❑ Zoning Status;CUP;
<br /> OWNS ADDRESS (N/umber,Street,City,Sate,Zip) Deed Restriction; CSM
<br /> .36 694 b,ii L G r mae/f-c✓l 53 7/2 Variance(# )
<br /> HOME PHONE CELLLL PHONE E-MAIL ADDRESS
<br /> $g'6- 33 N Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME / CONTRA TO NAME
<br /> Ni/e 4l�cch dew D. f7. gs Ici/■ U Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS` of well/septic
<br /> VI sic ....,j Arc. 3/62_ Pi ciy-cam-/ Ave.
<br /> (City,State,Zip) (City,State',Zip) El Setbacks
<br /> 1/1?I cbre/t W t"5_ 5370 % Y'24d' -Un ‘,,i 3. 3170
<br /> PHONE PHONE Site Plan approval from
<br /> c
<br /> 6,fi- 3115- 7S-0 t pg'-31/S' 75-c° applicable township.
<br /> E-MAIL ADDRESS ` E-MAIL ADDRESS
<br /> 1 Floor plans to scale
<br /> d ,e n4 . CUB
<br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) �( Elevation of property
<br /> PARENT PARCEL NUMBER: CURREN ONING: ACREAGE: 'f' P p y•❑ PARCEL �, Q(Pg 3 I Z 7O6 0 /� 4,, 1, 6 frontage drawn to scale.
<br /> NUMBER r!/v [� rJ � ''
<br /> TOWNSHIP: SECTION:
<br /> SD't',,-4-1-1,.'e 1 ti 11 .1/4: , IA: W Driveway permits
<br /> ADDRESS- / I (state,county,town)
<br /> /Of g' ,4v/v M? Pevt ci -Fr c
<br /> Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> / Av/vrwt I / (public,private)
<br /> p�✓�G�
<br /> PROPOSED PROJECT INFORMATION Z' MIS EW
<br /> PROJECT DESCRIPTION: ,
<br /> 0 e N/,,� K O t O n i S 7
<br /> �1�t
<br /> • IKJ This project is a new building or structure. 'ti
<br /> a o e i �,
<br /> ❑This project is an addition/alteration to an existing building or structure. 4,
<br /> P 1 g 9i%yf 1/4 ,„-,,
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> . g
<br /> / 4 /�/ y�k2�y
<br /> (SEWER MSEPTIC 1 3 Zo S -00 rZ c 7 ,-,-
<br /> HEIGHT IN FEET: 3 l NUMBER OF STORIES: (Not including basement) ! .,
<br /> 'Z U 1
<br /> AREA TO NEAREST SQUARE FOOT: 4
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) L;E u $ it ,
<br /> BASEMENT: 1ST FLOOR: s '�
<br /> j 700 2 r,3 2_ 4, TOTAL SQUARE FOOTAGE: ,, , +• j! 5tu1"b$I C t
<br /> 2ND FLOOR: 3RD FLOOR: J(/ , a ess)
<br /> Z S S 70/
<br /> z 17
<br /> diiition sum
<br /> ESTIMATED CONSTRUCTION COST: $ 00 6v Sva options. ,
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 0 (' ; ; .
<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 ,No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? MYes ❑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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