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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OW ER NAME
<br /> /V(4r—t 1IA '*' A� Gjv et-) .All 61.E 'f`try ❑ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> ", 11 Deed Restriction;CSM
<br /> 60. Tao 4 HAS j/ .hye, Sii 1 1—Vei/N('t W i 5-3 S 7 Q Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ', :r 2° 1S3 ,0)15- ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME /
<br /> TG L4 6-wSa.i r9ryer,?44 La.✓t >c Ait141.r.,/S ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRAC O(2 ADDRESS of well/septic
<br /> 53 SZv L4ne/l,6( a'•�' S:3.5�
<br /> (Cq,State,Zip) , 1 (City,State,Zip) t ❑ Setbacks
<br /> Ve° .cr , Iii. S 3 S�i3 Scut iP'4.11/' -C (A), S 3S •
<br /> PHONE PHONE ' ❑ Site Plan approval from
<br /> (,.90 x,73 S'• / OCo le7 ei, e, as-/rest, e, applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property
<br /> PARENT PARCE NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑ PARCEL o -2 yr G 1/ .3 3�),*- ,��j /4 , / `) -1 1 frontage drawn to scale.
<br /> NUMBER ! T ( / /'f ( �C
<br /> TOWNSHIP: SECTION:
<br /> 3v 'S }�I ,/4: ,%,A4. ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 3 3 5 /�►^S H N`t 1 t 1).A- Ste,"t P/4/ ~i,e_ ❑ Sanitary permits
<br /> CSM: 3^ LOT / SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION TAR REVIEW c'
<br /> PROJECT DESCRIPTION: x ' 4,, ,
<br /> J-r iG
<br /> AjEt,t) -- 41-. X 31 Deo--.,4a 46045,- 1 E3,i7f,-;66in, DV ilrar. This project is a new building or structure. E y <
<br /> ,- .�. ,,
<br /> This project is an addition/alteration to an existing building or structure. ;` �,��
<br /> 8
<br /> SANITARY SERVICE: PERMIT NUMBER: m s "" ' ;
<br /> (SEWER SEPTIC s new ems g,.
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) y
<br /> I+ a rchment) .
<br /> AREA TO NEAREST SQUARE FOOT: ''',47,.),!„.!".7.,',;:"7 .-,:-"',..,'_ C' P`
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .� " ; '
<br /> BASEMENT: 1ST FLOOR: � 70SIOflOn t @� ' ;
<br /> j TOTAL SQUARE FOOTAGE: j SOPS :.15:1:c o n
<br /> " f'Il i s �*
<br /> 2ND FLOOR: 3RD FLOOR: _
<br /> I JB''' io8f 4'
<br /> ESTIMATED CONSTRUCTION COST: s2 3 'r � 1ojy"`®o
<br /> (Please round to nearest dollar) i �� > �, �..�:
<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 ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ♦ —0. ■
<br /> 545-112(4/08)
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