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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CU;TOMER TO PROVIDE
<br /> OWNER E `J k c-°' "l y i 1J E Nt O c_tl
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<br /> onfrg Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)2-7 619 1, 11-Loa.- ( -D0 emoo)0' ) cc3S7S Deed Restriction; CSM
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<br /> HOME PHONE CELL PHONE E-MAIL
<br /> 69 Z7- '14(09 608 770 44(-9 C•ADDRESS
<br /> wk@ Q++, met to Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION end includes dimensions
<br /> AGENT NAME CONTRACTOR NAME /
<br /> 0---A M E M EQ T 1 ITI iite Plan including location
<br /> AGENT ADDRESS CONTRA TO ADDRESS f well/septic
<br /> /(City,State,Zip) (City,State, Setbacks
<br /> 0N` S3 7 fs
<br /> PHONE PHONE ❑ e Plan ap val from
<br /> 609 347 7167 p lira ownship.
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> m e re-++ Aei VA 4.1 t, CD w‘ — . oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (hitp://accessdane.co.dane.wi.us/) I/elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: 11, F�4CRE GE: '�J_
<br /> ❑ PARCEL �/D _073_8 .� CX. ,4 ��` �0 frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP:
<br /> • SECTION:
<br /> V/V, 0 7 1/. %S /: Vi._ ❑
<br /> Drivew ermits
<br /> (sta ,county,town)
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<br /> ADDRESS:
<br /> Z 7S8 L.,AL-0/2 !Z9 , o(t o"), wz 5 3,5"7S
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ID Sanita •ermits
<br /> (pub' ,private)
<br /> PROPOSED PROJECT INFORMATION
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<br /> PROJECT DESCRIPTION: -` A D A, )11!' ( '
<br /> C77 'V\ r d yvl.. �,/`I p- ► _ . intrDistrict
<br /> ❑T •' oject is a new building or structure. ed ?
<br /> This project is an addition/alteration to an existing building or structure.
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<br /> SANITARY SERVICE: PERMIT NUMBER:
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<br /> nSEWER EPTIC : k,
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) i? '' ate/
<br /> /7 ' r ut win i6
<br /> AREA TO NEAREST SQUARE FOOT: 4ch ;
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FOOR: l � %%
<br /> I 11 i j TOTAL SQUARE FOOTAGE: j t`"s• -,," ,,i nk,
<br /> 'V ' IO S Gam'
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<br /> 2ND FLOOR: 3RD FLOOR: 313 s i: 0
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -10 ♦ -11. 835- orfo`C0 c
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<br /> (Please round to nearest dollar) l am,
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<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? Dye), to ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? B9es ❑N
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if e)
<br /> 6. Is a location survey required? (see reverse) ['Yes No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes EI
<br /> 545-112(4/08) 1 74(. 7S
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back)
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