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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME �f hoy-- 1
<br /> l- eo E t h ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> Po 'IC 42.f , 5 b k las; (,,rj S3S ;Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS r
<br /> 6C6-8739?of 1 to Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION /and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME 7
<br /> i ar")1,4(f 1- © Si Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic
<br /> I -7 A/ fratiir6 s
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> PHONE PHONE �� 63531
<br /> 1=1 aPKS Si ' Plan K-
<br /> oval from
<br /> 663—Fj3-62-7 7 pplirc,abie township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS IOOr plans to scale
<br /> Cif COuh+ ConstnicI'Ion/ice a��.c p
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y
<br /> El PARCEL 5/ frontage drawn to le.
<br /> NUMBER 0511 otf'{g3S0� —Z �. b ,t=
<br /> TOWNSHIP: SECTION: S N W�
<br /> Ath k•/rk L4 '/4: %'/a: � ❑ Driveway p6(its
<br /> ADDRESS: (Stator COUnty,t9 in)
<br /> 5 ) us Nw S ( 511&4(6-,, -t_ r
<br /> �J / ❑ Sanitary mits
<br /> CSM: LO r SUBDIVISION BLOCK/LOT (p private)
<br /> PROJECT DESCRIPTION: � j
<br /> District
<br /> •
<br /> a� � C �� 4 !
<br /> . This project is a new building or structure. ,itted
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<br /> ❑This project is an addition/alteration to an existing building or str ct „ , ,67.
<br /> SANITARY SERVICE: I PERMIT NUMBER: ` I
<br /> „,``"• "
<br /> I
<br /> f SEWER SEPTIC 1 V -' ( r
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not i cluding basement) 1J'
<br /> S • ! 6AP"•< i
<br /> AREA TO NEAREST SQUARE FOOT: y 1,
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .'::(41,„,,,:!,:,:c.:'"'"1,1/-1/,,,f,?Zi,,,-,,.,:,141::;, 7
<br /> BASEMENT: 1ST FLOOR: ic) (lJ1^-�
<br /> TOTAL SQUARE FOOTAGE: 4, (-'••::, * ...
<br /> �l D V ii,/h, S,�
<br /> 2ND FLOOR: 3RD FLOOR: 2So �/
<br /> Er, w'Location Sutvey
<br /> ESTIMATED CONSTRUCTION COST: t 5�2�°`/ a e r r • GClS.
<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 ErNo Q Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2No ❑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 [gNo ['Don't know
<br /> 7. Is this to correct a violation? ['Yes EINo
<br /> APPLICATION MUST BE SIGNED.4q\
<br /> 545112(4/08) / 1-1 (Continue on Back)Co ,
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