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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NA
<br /> J",f Ae,-7 z c / e'/e L io" 0 ❑ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) / �—..3.1-79
<br /> Deed Restriction; CSM
<br /> 9"9-3 T/'/e'��4/7 1z�%C, �,_e1 0.� Lel Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> g3 5= 9'Z' £7 2/5----790 7 ✓ I-6,o S od e--.S" . c- v „-,
<br /> ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR 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 /> ❑ PARCEL ovz/.0 SZt7.-/7/•-971"7 ,'/'3 /d frontage drawn to scale.
<br /> TOWNSHIP: SECTION: cC SK,-
<br /> Q/Zr(,-O/V 7.-s-P' S&/a: 44::.7y1 5Y'/e'/a: Z ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> '93 7-ft/'F?F7/cj /2 Ot-e.S•o.1 tv/ 5- 3573—35 73
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION ,STAFF REVIEW
<br /> PROJECT DESCRIPTIO,)`l /;, ' ,0`,;,7:
<br /> !�,/c= s`ie :' ''" 46- -'S'� -Zoniii4 D
<br /> . N This project is a new building or structure. y i� �F s '
<br /> � ��.
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER:K ;E,, ii T ,-i.° -.4;:A'-,,
<br /> SEWER SEPTIC t
<br /> wag &4,4-,4:';4,1z
<br /> ,:x
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4 ,,=
<br /> - C N�- C Wetl fin!
<br /> tioreland (attachment)
<br /> AREA TO NEAREST SQUARE FOOT: ,
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ?- 9,,;,
<br /> L Emma r -a ltrc>�3 s -,
<br /> BASEMENT: 1ST FLOOR: i d ce j TOTAL SQUARE FOOTAGE: 4, s „`s surb ,
<br /> filling/access) k
<br /> 2ND FLOOR: 3RD FLOOR: '1
<br /> 7 Rey ovation Survey
<br /> ESTIMATED CONSTRUCTION COST: Q� �B t 'i
<br /> ♦ ♦ ♦ ♦ ♦ ♦ $ // a00
<br /> (Please round to nearest dollar) / 1-„:,a „ ,V , ,, •
<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? ['Yes ENo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? OYes ❑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 allo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes 174No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -* ♦ -
<br /> 545-112(4/08)
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