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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 /> sPc, A4-Li fk, (;),,,,I),,,,,,,.;-,__, L L l_- ❑ Zoning us;CUP;
<br /> OWNER ADDRESS (Number,Street,City,Stafd,Zip) De estriction; CSM
<br /> 4/Ws Fe-.L-r�re..i_,.- 1 /A--z./ A%ea'C �, t,v,(--"--- S3 Z (#HOME PHONE CELL PHONE E-MAILADDRESS ( ariance
<br /> - -0SZ(o 620Z --3 -1115 " i €vtA.)-.S ) L"- Co------p 8 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> `-.j, ( q c-(.g,-J S.,;(mot, ❑ Site Pla eluding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS If e /septic
<br /> _)-s- . .v3�x 620 r 3Z
<br /> (City,State,Zip) (City,Stat ,T ) Setbacks
<br /> /11:J.,(1 .1-z,,,_� �• 5,3,,5- Z
<br /> PHONE PHONE ❑ Site Plan royal from
<br /> 83 j . / Li appli a township.
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> loor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E "vation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREEA/GE: f Outage drawn to scale.
<br /> 0 PARCEL 0,210 J .Ds Z-d—40_0 G Z (�
<br /> NUMBER
<br /> TOWNSHIP: SECTI 9 1 ��
<br /> L ': i ,/4,/4. Driveway permits c 1/4 (state,county, wn)
<br /> ADDRESS: ��
<br /> '.-7 Z v1, k; e r.ivtr ❑ Sanitary'permits
<br /> CSM: LOT 1 SUBDIVISIID N4^ BLOCK/LOT (p 19.1ia,private)
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PRO ECT DESCRIPTION: "1 r
<br /> ..S �, 1 t (�1� Zanlnc f4tr[et 9
<br /> . yi. This project is a new building or structure. ,- s Permitted Used
<br /> ❑This project is an additio /alteration to an existing building or structure
<br /> SANITARY SERVICE: PERMIT NUMBER: IQ J ❑ Kuerfa di
<br /> l❑SEWER SEPTIC (nN 3isn() r i,
<br /> HEIGHT IN FEET: ^ ` / NUMBER OF STORIES: (Not including basement) t0',,,,:`;',: +y t ln/ q E
<br /> Is"'"\ yore - d'(at c m st,)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,
<br /> BASEMENT: 1 ST FLOOR: roslo9,:9T.I perm)
<br /> n ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbances i
<br /> 0 filttng/access),i y
<br /> 2ND FLOOR: 3RD FLOOR: %0). 0 0 ^; one 1
<br /> U z ,
<br /> ❑ R' v.few>-oeat 0.6 Surrey Q'J
<br /> ESTIMATED CONSTRUCTION COST: n l Rd aVallab[eopt ons 4`f
<br /> (Please round to nearest dollar) ♦ --► ♦ ♦ ♦ ♦ $ O0 t 1 i',�CJ t`
<br /> 1 „N.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? I s Cl/40 ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑ es ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (le ve blank if none)
<br /> 6. Is a location survey required? (see reverse) es ❑ o ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes o
<br /> 4- APPLICATION MUST BE SIGNED
<br /> g p (Continue on Back) -► ♦ -►
<br /> 545-112(4/08) t
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