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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION
<br /> OWNER E CUSTOMER TO PROVIDE
<br /> OWNE'A�CRESS r, et,City, rate,Zip) �t Zoning Status; CUP; L
<br /> 670 1C I w v Deed Restriction; CSM ��
<br /> HOME PHONE CELL PHONE Variance(# )
<br /> E-MAIL ADDRESS
<br /> ite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 21Site P • cluding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS ell/septi
<br /> (City,State,Zip) (City,State,Zip) ifSf Setbacks C'3/301)//.6
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<br /> PHONE PHONE OSite Plan approval from /4_
<br /> applicable township. /��
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> ,XI Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT bRONIU;16 :11 CURRENTZ NIN 1 ACREAGE /� Elevation of property
<br /> u PARCEL /J NUMBER ���, �� , A. frontage drawn to scale.
<br /> TOWNSHIP: SECT Dpi, ,/'
<br /> 1t ti— ev, L ��: ,� r' , ,�: ,\Driveway per ...-
<br /> ADDRESS: (state,coun,,to n)
<br /> Sac
<br /> CSM: LOT SUBDIVISION BLOCK/LOT 4 Sanitary . - is
<br /> (public, 4110
<br /> PROPOSED PROJECT INFORMATION ,, ...TAF"F REVIEW
<br /> PROJECT DESC�PTION: I t
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<br /> I= _�. I t1 �G o< S 6 r �Zoning Qlstr�t� ,4,,,:,,,,; v�
<br /> U This project is a new b ;;, • or structure. ..
<br /> •
<br /> 3 /x 3D / Z v ' Permitted Use` . 1-C
<br /> XThis project is . addition/alteration : an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: Rural..' + SS
<br /> ❑SEWER I'd SEPTIC
<br /> f 04 exis to)'�
<br /> HEIGHT IN FEET: .2-0 NUMBER OF STORIES: (No including basement)
<br /> #447,:,,,T;'''::7311OO61156int''--kk'''''', :,
<br /> AREA TO NEAREST SQUARE FOOT: oref (attichment
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) x ' t
<br /> BASEMENT: 1ST FLOOR: ;i�ECa9lor�on�Ct�f�ermi
<br /> 9 TOTAL SQUARE FOOTAGE: 4, - (sFopes,d turbaInce,
<br /> 2ND FLOOR: 8111[1 1,49,,.t sS ` ' `
<br /> 3RD FLOOR: /}� ^ 9 c ). A f
<br /> f0( U ,, l
<br /> ESTIMATED CONSTRUCTION COST:
<br /> C Review Location Survey
<br /> (Please round to nearest dollar) ♦ '� ♦ "► -► -0. gd and aiiii4breY:60l hS
<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 ❑No ❑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? ❑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 N
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4108) (Continue on Back) -► -4. -►
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