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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> i OWNER NAME
<br /> 6714 4. 6 '4 i 0 Zoning Status;CUP; A ,1
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM
<br /> /02-CO CT - L/ / fr2-Orft,1-4//g- WI 57307 Variance(# )
<br /> HOME PHONE CELL PHONE -. E-MAIL ADDRESS
<br /> I- Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION -nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> f AA/LS j1.F)� !i/ /43 //it✓, k'Site Plan '• •ing location
<br /> AGENT ADDRESS t CONTRACTOR ADDRESS of w- ep is
<br /> -n►�' p. 4i2 5 y /c7
<br /> (City,State,Zip) (City,State,Zip) p:/ Setbacks ,
<br /> Sri e �- -nt, w I <-3S-iS i 7�
<br /> PHONE PHONE `rAl Site Plan approval from .1 0
<br /> gi / (OC�A, 76P7— 17Z�i a•plicable township. )/
<br /> E-MAIL ADDRESS > E-MAIL ADDRESS
<br /> PiIAAS6 54V- dS,C, , 0 0 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn
<br /> PARENT PARCEL NUMBER: CURRENT ZON( <'G: ACREAG E: Elevation of ro e rty
<br /> El PARCEL frontage drawn to scale.NUMBER /CZ I 0 A- l I
<br /> TOWN*Wit SECTION:
<br /> /} OM Vi 22.. ' : 5W 1/1/<: rs 0. Drivew. •- I its
<br /> ADDRESS:
<br /> /� � (state, ounty •Wn)
<br /> CSM: LOT r �6UB SUBDIVISION BLOCK/LOT 00 Sanitary ills
<br /> NJ4 Al Ai' N 4 (public r
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: --iF a 4,1 le
<br /> /?Pope` �c,rul.--/V) , e--.1e--- 4- : 4400/Pair/ 511 t
<br /> ❑This project is a new building or structure. ;; 1
<br /> 1g-his project is an addition/alteration to an existing building or structure. ' /
<br /> SANITARY SERVICE: PERMIT NUMBER: V. ®*
<br /> E.EWER �•EPTIC €` � rg
<br /> HEIGHT IN FEET: I r.
<br /> NUMBER OF STORIES: (Not including basement) ,: r '
<br /> 41 -0 a I-tp,g, ' 7:.,.:4;.:.74.f !.,r=:!,:::q:,.„::;~,o-,t-
<br /> AREA TO NEAREST SQUARE FOOT: $ n d Y'
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) / '
<br /> ' * $ � ,
<br /> BASEMENT: I 1ST FLOOR: � ®y 't
<br /> 1/08 Cr /j / ,5-F j TOTAL SQUARE FOOTAGE: 1 g # ,,,, f
<br /> WC 2ND FLOOR 3RD FLOOR:
<br /> /006,._ ' NA /-/Z-// _sr ,,,',;;iL r '":``°4','°,, ,:':4 ,
<br /> ESTIMATED CONSTRUCTION COST:
<br /> • ,. eras
<br /> (Please round to nearest dollar) ♦ "� ♦ 1 4----ii ©� � ,,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? YYes No ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Eyes ❑No ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 13Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ErNo
<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 EiNo ❑Don't know
<br /> 7. Is this to correct a violation? [-Yes 2No
<br /> 545-112(8/09) �j O ^ APPLICATION MUST BE SIGNED
<br /> U 2 ,‘DO / (Continue on Back) ■ -+ -►
<br /> /d 2._ 1 , CT 1 Y
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