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ZONING PERMIT APPLICATION Www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> -, .1
<br /> OWNER ADDFtSS (Number,Street,City,State,Zip) ❑ Zoning Status; CUP;
<br /> '�� (��, La., Deed Restriction; CSM
<br /> kti. s / c37 (I Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL AI DRESS
<br /> 3 4,3 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> a_ 2,t,u-d.c&L. GL i)5 S‘4`"-e-- ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> O 6d 2 $ 4rE L-,t.`� -`.14-4-`.c."
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> we ".ti" ;r37 I( rte.,,, e.
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 27 l — (,,e. -?__ / S, applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.daACREAGE:ne.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ❑ Elevation of property
<br /> ❑ PARCEL frontage drawn to scale.
<br /> NUMBER 63 '-D-I OS''D 4'I — I-.4. -C�
<br /> TOWNSHIP: SECTION:
<br /> M", &Le:-&hi'v N F` 1/a: Sr:- 1/41/4: G ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 768o P4 Y ti -C-it,,d.., ❑ Sanitary permits
<br /> SUBDIVISION BLOCK/LOT (public,private)
<br /> 0c-k d a( ks , ,c
<br /> PROPOSED PROJECT INFORMATION STAFF IIVIIEVf
<br /> PROJE T DESCRIPTION:
<br /> 44 /4- AJE� /1--0/14,F ❑ Zoning District :�
<br /> . This project is a new building or structure.
<br /> ❑ Permitted.0- 6.7.'::'`.;:1
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: ,
<br /> PERMIT ❑ Rtaral�FcCdreSS
<br /> LI SEWER SEPTIC ( g)
<br /> new/e�clstti �,�� ���
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ?1-e W 0„1 .9 C aWhtratt lFlaottac nt
<br /> AREA TO NEAREST SQUARE FOOT: St orelartd late cveci y� i,
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> ❑
<br /> BA MENT: 1ST FLOOR: ErOSIonCo 09t ,,,LT
<br /> l ! j TOTAL SQUARE FOOTAGE: (slopes,disturbanc f
<br /> 2ND FLOOR: filllirt /acc sS °rte _ ":
<br /> 3RD FLOOR: I/11 Z li!,e ^ 53-3?- g 2:51.1•':01,t!"',.:,,„::,9 ,,,::,,,:,,�
<br /> tu Review!_ocatlan Survey
<br /> ESTIMATED CONSTRUCTION COST: --► _ _ _o, and available opti ns
<br /> (Please round to nearest dollar)(}/�d V
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l76o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Oh--o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Li Yes O'Iclo
<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? 5.0 ❑Yes a
<br /> q30°
<br /> GL __, APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) �� , ({J') (Continue on Back) -► -► -►
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