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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION
<br /> OWNER NAME CU '.TOMER TO PROVIDE
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Ij Wing Status; CUP;
<br /> /0'1 3‘ G f y ! t' @ /vt v �S S'�57 1 eed Restriction;CSM
<br /> HOME PHONE CELL PHONE E-MAILADDRESS fiance(# )
<br /> 608 - S76.-Y 37 V S a. ;h .r 4 6 m4.1 c,
<br /> AGENT INFORMATION CONTRACTOR INFORMATION ❑ ite includes drawn a lion
<br /> AGENT NAME nd includes dimensions
<br /> CONTRACTOR NAME
<br /> AGENT ADDRESS ❑ S e Plan including location
<br /> CONTRA TOR ADDRESS well/septic
<br /> •
<br /> (City,State,Zip)
<br /> (City,Stat ,Zip) ❑ Setbacks
<br /> PHONE j'�
<br /> PHONE 1 ite Plan,aOproval from
<br /> r a lica a township.
<br /> E-MAIL ADDRESS
<br /> E-MAIL ADDRESS
<br /> d lour plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT P(CAR LAN MBER. b CURRE ZON ACR GE: Elevation of property
<br /> ❑ NUMBER , O(oa , ay .. ` i-kr �,
<br /> / frontage drawn to scale.
<br /> TOWNSHIP: SECF4ON:
<br /> �S v L tin v n c(' Y %: N k.1 %%: S ❑ Drivewa 13ermits
<br /> ADDRESS: ' (Stat ,county,town)
<br /> CSM: LOT SUBDIVI ION ❑ Sanita private)
<br /> S
<br /> BLOCK/LOT
<br /> 'pi!• 'c,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> FOJEC9T DESCf PcRN.:. / %0 1,0... S j
<br /> P , i
<br /> rte,at3 sv , /
<br /> • This project is a new building or structure.
<br /> ❑This project is an additior)✓alteration to an existing building or structure. t . ;
<br /> SANITARY SERVICE: 1 °'
<br /> PERMIT NUMBER: n ' 1 � .k ,Fs',
<br /> F1SEWER v
<br /> SEPTIC a , „,,,,,
<br /> HEIGHT IN FEET NUMBER O STORES: (Not incl ding basement ,,,, ,,,,_,,g ,.,:„,,,,,,„,,,,,,,,z ,„„,•,,,AREA TO NEAREST SQUARE FOOT: '0,,z, 4'45,', ' }
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) E
<br /> BASEMENT: 1ST FLOOR: -
<br /> 4. TOTAL SQUARE FOOTAGE ,� f $ 2!4°.: ; ,
<br /> 2ND FLOOR: 3RD FLOOR: 1 O O : ).4.aft° „4 z 'u
<br /> (J
<br /> ESTIMATED CONSTRUCTION COST: $ (�
<br /> (Please round to nearest dollar) ♦ ♦ I ff,, ..1, ,,, 4
<br /> 1. The property is within 300 feet of a stream or 1000 f et from a pond or lake? Yes
<br /> 2. Is there a wetland or floodplain on or near the prope y? ❑ ! ° ❑Don't know
<br /> No 0 Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No
<br /> 4. Has there been a zoning permit issued for this prope y in the past 5 years? Yes ON/
<br /> 5. Is this project associated with a rezone/CUP/varianc (petition/appeal#
<br /> 6. Is a location survey required? (see reverse) ) (leave blankaf one)
<br /> ❑Yes o El Don't know
<br /> 7. Is this to correct a violation?
<br /> ❑Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112 taioal (Continue on Back) ■ ■ .♦
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