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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE
<br /> OWNER NAME 0
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) �I Zo g Status; CUP;
<br /> c C G r -- / ve.r oN", _ / r 3 sa 3 De
<br /> i dncee(#fiction; CSM
<br /> -
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS J
<br /> goq - c1s-Cbs-�' .). Avoc.-Recso-:.-rt` «Jv'^n,l-(-aw.
<br /> ite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Dcz`k, K, LA t S pv. i Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> PHONE PHONE S.a PI approval from
<br /> G o e- 7 6 ck — O q i( i ble township.
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> ,,, i.A,+ Oh S,'k 0 • 3.v,O1 ,I, c oh% loor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E vation of prope PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p e
<br /> ❑ PARCEL -S//11\ ci o (y L o-f�); 1 A 1 1. S-i f ontage draw o scale
<br /> NUMBER �� /` O 3�.� cY.�l 0)
<br /> TOWNSHIP: lQ � 1 TION�f �.
<br /> p, �l ,�4: ,�a,�4: r� I., Drivew. permits
<br /> ADDRESS: (stat=, aunty,town)
<br /> e6 - v L S Sa ita permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ p
<br /> O� p. .I. ,private)
<br /> PROPOSED PROJECT INFORMATION oy ;STAFF BENIGN
<br /> PROJECT DESCRIPTION: " '
<br /> YC',./ 0L2-+aGLe,ot AarA..te I C) 1 �J Zoning �
<br /> . ['This project is a new building or structure. :
<br /> ❑This project is an additio alteration to an existing building or structur .
<br /> SANITARY SERVICE: PERMIT NUMBER: 13 RuIrS . ''v/ ,,
<br /> nSEWER SEPTIC (newt-4a'
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not includi g basement) „
<br /> € s))•sa• €
<br /> AREA TO NEAREST SQUARE FOOT: g ; g
<br /> (Outside dimensions including unfinished area,attached arages and above grade decks or porches) ,6 l '
<br /> BASEMENT: 1ST FLOOR:
<br /> lc)0 1 TOTAL SQUARE FOOTAGE: ($(s6 { €,�1 i rife, ,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: $ \x 0
<br /> (Please ♦ ♦ ♦ ♦ ♦ ♦ ��o
<br /> -,,,),f5„,,,,..; ;..;::"\,;,:.,..-,•,„f : at e
<br /> Please round to nearest dollar)
<br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EiNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Ves ONo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? s ❑No
<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) El Yes No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No.4 545-112(4/08) /
<br /> e-------- APPLICATION MUST BE SIGNED
<br /> I�' (Continue on Back) ♦ ♦
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