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ZONING PERMIT APPLICATION www.countyofdane.co111 SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE
<br /> OWNER NAME
<br /> an n f 0 e5.5- lei ai oning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) 7
<br /> (07(/ MA)y F Q'kie Movr 5 wl cJ 5/ / Va Deed Restriction; CSM )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> tor- 37- 315T 6o- ai z-sJ Yo d ro e3s le, E? �-i-G . n of 2 to Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION - nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> PHONE PHONE to Plan approval from
<br /> . .plicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> . ` Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.io.dane:wi.us/),
<br /> PARENT PARCEL UMBER: /CUR ENT ZONING: ACREAGE: ' • Elevation of prope
<br /> El PARCEL —NUMBER /�/� 0 I 1 ��� frontage drawn Cale.
<br /> TOWNSHIP: SEC1X
<br /> Uti ,‘ p{ 6 1 U L M 100/4s
<br /> /• 11. p�� ❑ Drivewa ermits
<br /> ADDRESS: (State ounty .wn)
<br /> 269Y NL✓y F 4It,t 1110 .,,x. lv_' �-7s77
<br /> CSM: / LOT SUBDIVISION BLOCIVLOT ❑ Sanita •ermits
<br /> g �1Q0 / (pub' ,private)
<br /> PROPOSED PROJECT INFORMATION s STAB REVD
<br /> PROJECT DESCRIPTION: ,,,,,,I. , :,---:-7"--; . '' "
<br /> —)& e 0 -N( Ali l'n'tdin-This project is a new building or structure. J:� ��t�:
<br /> P 1 9 .� ,Paaa � b
<br /> ❑This project is an additio Iteration to an existing building or stru ur- y µ< - �`_ r,a SANITARY SERVICE: PERMIT NUMBER: Air s
<br /> 1-1SEWER SEPTIC 'i'� �Ik .
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not i cludin.basement) r
<br /> e:2(...S) chorea r'
<br /> AREA TO NEAREST SQUARE FOOT -
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ` �` " ` { �; 4r'
<br /> � 1'�� '���5(7ASoo,�Q . s tom _-
<br /> BASEMENT 1ST FLOOR: �\` \ i
<br /> C_�J/ 4, TOTAL SQUARE FOOTAGE j a O o g e c
<br /> 2ND FLOOR: 3RD FLOOR: i _�—■m�: ,-1„,,,f.:=:,,,7-__,,,,,..._.:. .„...-.,:: 3.-- ,....-__;::. ,,,,, ,
<br /> ' I ���� Fro - ( f torte o-0 * : i f .
<br /> fnrf
<br /> ESTIMATED CONSTRUCTION COST: o ` , -
<br /> —0- -0- -0. -0- -0- O a. -9 Y(Please round to nearest dollar)
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 1=1 Yes 1No ❑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? s El 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) Yes ❑ o ❑Don't know
<br /> 7. Is this to correct a violation? El Yes o
<br /> r_` � APPLICATION MUST BE SIGNED—0-I (Continue on Back) —►
<br /> 545-112(4/09)
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