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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE'
<br /> OWNER ,ME
<br /> _ 6 co✓ i e s• ez.c:,,! S,m/0�,4 ,4 Zoning Status; CUP; r7 -2 t,
<br /> OWNER ADDRESS (Number,Street,City, to ,Zip) Deed Restriction; CSM " °5
<br /> 6 .5 ee 4, 1 Ji,iov i '9. LDZ .5353 7 _ Variance(# )
<br /> HOME PHONE CELL PHONE -MAIL ADDRESS
<br /> 6aa ,771.9Y bah°i,-f 74x. XSite Plan drawn to scale /1"--.... 5o '
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME / CONTRA TOR NAME
<br /> Po ZG� //#€- 6-/w ��ecA ',/w e1 ' 1 Vim' Site P ding location
<br /> AGENT ADDRESS n AP CONTRACTO- ,DDRESS o w II/septic
<br /> 10161453 ' " [. e/ l90 Y2 0li AC/!09 5-..I 4 .-?q 5
<br /> (City,St Zip) (City,State,Zip) Setbacks / /
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<br /> g/be/1ct, �r �3, ba VP, ock c.�r 5-35'
<br /> PHONE J PHONE Site Plan approval from , /
<br /> -771)-Ogol-5— koi-13Y5-97b,p applicable township.
<br /> E-MATIADDRESS E-MAIL ADDRESS
<br /> '61e/c,.,,„'61e/c,.,,„ bc»/ei , rv� Floor plans to scale
<br /> c ZGc h
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: p p y
<br /> El PARCEL k/-/ a .7, 97 frontage drawn to scale.
<br /> NUMBER /D3/1' -a9/f-&yD--O
<br /> TOWNSHIP: / SECTION: l '-
<br /> R4 Heti di 7" ) 1/4: 1 V L 141/: .. /— Driveway per •. A_
<br /> ADDRESS: (state,count ,tow►)
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<br /> LOT SUBDIVISION BLOCK/LOT , Sanitary Sanitary p- s
<br /> CSM:
<br /> ii Z / (public, .ar
<br /> PROPOSED PROJECT INFORMATION STAFF RE IEW
<br /> PROJECT DESCRIPTION:
<br /> /"D X ?V tie 241 D/�/7 Lc..„ cn (p„/40f 3c 9/x/09 Zoning District
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<br /> . ❑This project is a new building or structure. )®9 permitted Use?,' At .;, ”
<br /> an-his project is an addition/alteration to an existing building or structure. , ' . - ' :::.,-,, ..;,;:4.17-.211:: .;1''
<br /> SANITARY SERVICE: 04 SEPTIC NUMBER: Rural Add eSS ry'
<br /> ❑SEWER /i0.1 SEPTIC (neW/ (n° /
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<br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) . z
<br /> )' ' w .. F1oo4149n
<br /> hore an• (attachment} f
<br /> AREA TO NEAREST SQUARE FOOT: `
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) In,
<br /> BASEMENT 1ST FLOOR: T .
<br /> — 9 cep L� J/ ,', TOTAL SQUARE FOOTAGE: j (SlOpea [St[.1i0bCtce
<br /> J d ft[(ittooc4ss
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 9 lip
<br /> ESTIMATED CONSTRUCTION COST: 1 Revie*LaCattola Survey
<br /> -► —► —► —► -► -► 9�/o ff and available options IT-
<br /> (Please round to nearest dollar) #
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L7 No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes CirNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 13-Rio
<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' none)
<br /> 6. Is a location survey required? (see reverse) &fCies lr No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes liNo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ■ ♦ -P
<br /> 545-112(4/08)
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