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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME I
<br /> I cl1nd SOh\G Go cc ❑ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ JJ Deed Restriction; CSM
<br /> (q"/P. 14 e(c� . UJC�, , o(f 6- k)-�- �� Co� Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> s N," '.I.- H$1 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME , CONTRACTOR NAME
<br /> )C 1 AO/ A c:1S(tn t i k -OcSc c,�Ir, ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS UU of well/septic
<br /> 1 o <S c kl�Gk l 1 o S,�'cJ\,(C4- e4
<br /> (City,s e,Zip) , (City, :tip) _ ❑ Setbacks
<br /> i� 1��-._ I- �.\(,LL E,4r�L, ) WI 515-
<br /> PHONE PHONE ❑ Site Plan approval
<br /> from
<br /> D;6- N bo%-Dds - applicable townshi p.
<br /> E-MAIL ADDRESS E-MAIL ADDRES 1l -
<br /> .,10 al tlIN(1-c;(�,6)J ('tSt I •64 ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE:
<br /> ❑ PARCEL (� //�� 1:$11 frontage drawn to scale.
<br /> NUMBER CAI0- - -1 ©a ���(
<br /> TOWNSHIP: SECTION:
<br /> ;W1T;ASOC 1/4: ,%,A: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> lS 7D, 1 I Oa-. y I a �� 1 - S e El Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION ,
<br /> STAFF'REVIEW„
<br /> PROJECT DESCRIPTION: , x � '
<br /> onlna s ;t'"
<br /> . ❑This project is a new building or structure. t Mi' ° ,
<br /> 1.24his project is an addition/alteration to an existing building or structure. ���
<br /> SANITARY SERVICE: PERMIT NUMBER: _� : 1 t
<br /> WER SEPTIC <. e�, B i
<br /> HEIGHT IN FEET NUMBER DF STORIES: (Not including basement) 'i`,
<br /> a4.,/ We anB �.�a�oo ,
<br /> Shore an: Ycchmeri ) `':
<br /> AREA TO NEAREST SQUARE FOOT: �' a , >In.,. .�r
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ _ t ,
<br /> BASEMENT: 1ST FLOOR: � �� r @ �
<br /> 4, TOTAL SQUARE FOOTAGE: 4, lifit ore ° v t�
<br /> 2ND FLOOR: 3RD FLOOR: -- • � ,,,;:,, ,%, Y`y
<br /> -72 C41,5,41'ir"Krig*If:45:42
<br /> ESTIMATED CONSTRUCTION COST:, K= • 'kl ®o e)4}.:,.;,
<br /> (Please round to nearest dollar) I D a- n
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes p No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ['Yes ONO
<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 0 No
<br /> u APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —0. ■
<br /> 545-112(4/08)
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