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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME p ,
<br /> ((�� hh 1 5
<br /> OWRADIRESS (Number,Street,City,State,Zi. ❑ Zoning Status; CUP;
<br /> Deed Restriction;CSM
<br /> A / I 2.%f 1/ .€1/. i1� Variance(# )
<br /> HOME PHONE /, I �-ESS r//lll " . 44 " , "1 NIF 6 "L All i.� / 1 ',s�/ !i I., / rL ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION (CONTRACTOR INFOf%✓1ATION and includes dimensions
<br /> AGENT NAME CONTRA TOR NAME
<br /> ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRADTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> 0 PARCEL
<br /> NUMBER Di4 D • . frontage drawn to scale.
<br /> T \ NSHIP: SECTION:
<br /> / 1/4: ,/4,/4. ❑ Driveway permits
<br /> f��r^�f1 (state,county,town)
<br /> ADDR SS: _
<br /> 1/0R sP' LOT STall �UB SUBDIVISION BLOCK/LOT El Sanitary permits
<br /> f/ (public, private)
<br /> PROPOSED PROJECT INFORMATION TAFF EW
<br /> PROJEC ESCR TION: °s' A � ,
<br /> sip , Ote
<br /> • ❑This project is a new building or structure. a ,;
<br /> This project is an addition/alteration to an existing building or structure. f -�
<br /> �r rte• � i
<br /> SANITARY SERVICE: PERMIT NUMBER: ,, u e ssress ,
<br /> f SEWER SEPTIC w e i "
<br /> HEIGHT IN F ET: NUMBED OF STORIES: (Not including basement) - fir
<br /> RTF:1,,,,,.v4,0otit.ii,„."94.4,6,th,t,,;® jnI 4 ;
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached g rages and above grade decks or porches)
<br /> IN�Ero-ton` e . . ,:
<br /> BASEMENT: 1ST FLOOR:
<br /> 4, TOTAL SQUARE FOOTAGE: ,� �, o e es,i i e ';
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: L $ /� andfav a Air,:
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ T� '♦ �V `' 3. ,o .1 '.,',,.#:
<br /> 1. The property is within 300 feet of a stream or 1 00 feet from a pond or lake? ❑Yes EtC ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes E J1 ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Droo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El
<br /> 5. Is this project associated with a rezone/CUP/variapce(petition/appeal# ) (leave blank if on- i i e
<br /> 6. Is a location survey required? (see reverse) Dyes No Ld Don't know
<br /> 7. Is this to correct a violation? air Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) — '
<br /> 545-112(4/08)
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