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SUPPLEMENT to:Web•App I
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION - CU TOM ER TO PROVIDE
<br /> OWNER NAME
<br /> of oti 4 'U& — ' Zo ing Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) /� �� D ed Restriction; CSM
<br /> �fQ',� .717� 1 %%%GGGGGG ) ariance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> q,s - 3//41- 60'ZZ c�i rte+, I ite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR.INFORMATION d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> fjrvjJ` 1 Jot '51,..5,a..,5 6,0 cii'. Le• it.) C, Site Plan including location
<br /> AGENTADD CONTRACTOR ADDRESS ) of well/septic
<br /> g1/ /dgLE1PeA-30
<br /> (City,State,Zip) (City,State,Zip) n Setbacks
<br /> 1,(A,4„6 LW.)►1V ( j 31 I .
<br /> PHONE "-RHONE C) c1 '•ite Plan ap oval from
<br /> L4/ -27) G ce-4' 32_ :pplic ownship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS '
<br /> 43GtaA aY tQ1 See).�r l, Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:I/accessdane.co.dane.wi:us!. _ Elevation of pro rfy
<br /> PARENT PARCEL NUMBER: CURRENIVONING ACREAGE.
<br /> ❑ PARCEL a90 -'06), �9 ' 90 / frontage dra to scale.ji NUMBER 1
<br /> TOWNSHIP: SECTI
<br /> V ;t I : %%:....,.. F ❑ Drivew permits
<br /> ADDRESS: lam, (stat ,coun , own)
<br /> ' % 43rATt rIVAD t'Vi 0 lz-cc 1 k 77C-75 ❑ Sanit permits
<br /> CSM:s I 0 LOT I SUBDIVISION BLOCK/LOT sub c,private)
<br /> PROPOSED PROJECT INFORMATION STAfF RE1/IEW '
<br /> PROJECT DESCRIPTION: /°�� , 4 F "` ---
<br /> Co if ttA��C( COP � �, , 0 �,.� onrng is ncA 1
<br /> . his project is a new building or structure. Fermi 'ase. - ,
<br /> Ej This project is an addition/alteration to an existing building or structure. t : ...
<br /> SANITARY SERVICE: N PERMIT NUMBER: /\J//4 SEPTIC -e s.- --z�a `1 HEIGHT IN FEET: NUMBER OF STORIES: (Not including b ment)
<br /> ��
<br /> ` Shore d attachm „ -
<br /> AREA TO NEAREST SQUARE FOOT: g� -% ,-'
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �- -� . z.- n;
<br /> ETosIloraCont perm .
<br /> BASEMENT 1ST FLOOR: s D e d anC
<br /> . C7 {`t j TOTAL SQUARE FOOTAGE: + p ,. _ ,�-,.
<br /> r r,7 fillinva o ,- t'
<br /> 2ND FLOOR: 3RD FLOOR: �d 00 F n , ,�..v.,.. ..„..,
<br /> �L1*�RE�/le -Rca IOmS11IVe ;1'-',:
<br /> ESTIMATED CONSTRUCTION COST: /y ,Z� and t e�pfion
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ "—r/ �� -__ •' ''' . ,,. ..a.. . ¢
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes SRo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,IJo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ,fiYes ❑No "
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'lo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# )j 0 ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes ,E4Nlo ❑Don't know
<br /> 7. Is this to correct a violation? ❑YesN
<br /> ATo
<br /> APPLICATION MUST BE SIGNED
<br /> �� �•, (Continue on Back) -0 --0 —I►
<br /> 545-112(4/08)
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