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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CU 1 TOMER TO PROVIDE
<br /> 0,14,1ER NAME �`
<br /> A? ,' / � J N l e u Z Wing Status;CUP;
<br /> OWNER ADDRESS (Number,Street', State,Zip) eed Restriction; CSM
<br /> 272 , Cot hri-y View A d Ue`o,.4q 4// - -' ariance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ,08- S-3.0/ ,Of 345=1665 d✓c/H(c' 0 td$•'re t
<br /> 8 tte Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> it Plan including location
<br /> AGENT ADDRESS CONTRA1CTOR ADDRESS of ell/septic
<br /> (City,State,Zip) (City,Statje,Zip) etbacks
<br /> PHONE PHONE ❑ Sit Plan pr rom
<br /> ap f I wnshjp.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> loor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation property
<br /> PARENT PP"ARCELNUM ER:: 2 Q� ?G�CURRfEENTZZONING: ACREAGE:
<br /> ❑
<br /> NUMBER
<br /> �J G(' ww l v r O R'I-1- I 2, ‘ fronts drawn cale.
<br /> TOWNSHIP: .
<br /> �D k 4 D 8' i 1/4: k/ 1/a1/4: stt/ ❑ Drive permits
<br /> ADDRESS: (st e,county,town)
<br /> 2721 Corr i't y I/ck, , I. Vero PtA , Gt.// ,f'3Sg3 ❑ Sani permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (. jC,private)
<br /> , /2 ,
<br /> PROPOSED PROJECT INFORMATION ` STAFF REVIEW
<br /> PROJECT DESCRIPTION: hey i
<br /> /Uoheti s/deieade /cve/ o ci< off of /f;tche,-, it ..14?: ‘, ',
<br /> . ❑This project is a new building or structure. i % F
<br /> Permitted�1 ,
<br /> Et This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: 1\s}(1).... , row.
<br /> f SEWER SEPTIC %A� 9 '
<br /> r us
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) I s
<br /> ,, , R„. Tents.
<br /> AREA TO NEAREST SQUARE FOOT: ,,y ,;,;4
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , ,
<br /> BASEMENT: 1ST FLOOR: �� s s �1"
<br /> TOTAL SQUARE FOOTAGE: j " ®istt,Irbance, ,
<br /> i
<br /> 2ND FLOOR: 3RD FLOOR: 38c� & )
<br /> lJ
<br /> ..#RwsrLocation
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �dSYs0t {3pt1€ 1S
<br /> (Please round to nearest dollar) 3, Sn D ,,f,,;„,,,,-;,1*''
<br /> 1. The property is within 300 feet of a stream or 100 feet from a pond or lake? ❑Yes elo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes `✓No ❑Don't know
<br /> 3. Have you talked with the township about your proj ct and are they in agreement? [ Yes ❑No
<br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? [Z]Yes ❑No
<br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes E o ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes m No
<br /> g,7e, 5 0 APPLICATION MUST BE SIGNED
<br /> (Continue on Back)
<br /> 545-112(aioa)
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