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SUPPLEMENT to.Web-APP.#;_'
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION ,-. . • CUSTOMER TO PROVIDE
<br /> OWNER NAME.
<br /> Witt. We be ~ n Zoning Status;CUP;
<br /> OWNER ADDRES,,5 (Nu tuber,,sire City,State,Zip) S Deed Restriction; CSM
<br /> ZvZ wd� ) V✓. mars("41 k , OV( 5-3 s9 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> Z19-1'38'1 n Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR'INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 54.,„,� Hon1zo�. frtai.,.�PS ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> C.l to co{-.�e ,C c ,.
<br /> (City,State,Zip) (City,State,Zip) El Setbacks
<br /> co iTc_1,e ( ov-e
<br /> PHONE PHONE m ❑ Site Plan approval from
<br /> &o r- (a ZO —3 rZ C• applicable township.
<br /> E-MAIL ADDRESS E-MAIL''DRESS
<br /> Hurl -t.‘Howe 0a-7 €79`+^a�r,,.,❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane:wLus/), - ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE:
<br /> ❑ PARCEL CZgY0(01 0-141-1-2z`I(, s Z ( ./41,3 frontage drawn to scale.
<br /> NUMBER ;
<br /> TOW� SECTION*
<br /> 10 w
<br /> ' ec wK� -1/4. ,/4,/; ❑ Driveway permits
<br /> ADDRESS: (state, county,town)
<br /> 2/gO C k v beset kt ci lea(
<br /> CSM: LOT SU DIVI oN BLOCK/LOT ❑ Sanitary permits
<br /> ,Z ��„ . -c (public,private)Lry „,e h _
<br /> PROPOSED PROJECT INFORMATION ; ,STJCII`'REV.I
<br /> PROJECT DESCRIPTION:
<br /> R/k ut) _ t R4.1"-C-k ,c nmg ® iQkt > ,1 ;
<br /> #ter a y T
<br /> • ®This project is a new building or structure. . 41
<br /> ❑This project is an addition/alteration to an existing building or structure ,,• ,a-4, z
<br /> SANITARY SERVICE: PERMIT NUMBER: :��, ._r d, k
<br /> SEWER (SEPTIC sane e e)'- . ``
<br /> HEIGHT IN FEET:/ NUMBER DF STORIES: (Not including basement) X*'T', ,ZA,,,'
<br /> Slaoreanw r • -
<br /> AREA TO NEAREST SQUARE FOOT: r° k f: "�e
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ``
<br /> ;x Tosiof1Gon e o e t -
<br /> BASEMEN 1ST FLOOR:
<br /> 14 CO 17?_ 4, TOTAL SQUARE FOOTAGE: j SO®e , .1S p_,r_ x�=
<br /> / 1 . r-r € . c. Ss s.k
<br /> 2ND FLOOR: 3RD FLOOR: c ,..;
<br /> 1 ± *
<br /> ESTIMATED CONSTRUCTION COST: 71,. .: = o"°7e
<br /> ( dollar) —O. —► —► —I► $ trip 0 0 a
<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 ©No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the prop rty? ❑Yes Ea No ❑Don't know
<br /> 3. Have you talked with the township about your proj ct and are they in agreement? EYes ❑No "
<br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? ❑Yes ®No
<br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) EYes fNo ©Don't know
<br /> 7. Is this to correct a violation? 1 ❑Yes p No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) - - -9 -►
<br /> 545-112(4/08)
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