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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 /> Ca.yrd e SAern/ PGO/OSOY) ❑Zoning Status; CUP;
<br /> O ER ADDRESS (Number,Street,City,State,Zip)
<br /> .-003 M%'" Ay L,7 /Yf4 rsAa// 4,,i S3 Deed Restriction; CSM
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ;og-,2g7-4'.2 93— ❑Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Q6fy gve4' Frey C'onSt- c./-ior) ❑Site Plan including location
<br /> AGENTADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 3---30 park /4v - Sc.rie
<br /> (City,State,Zip) // (City,State,Zip) ❑Setbacks
<br /> pr.,'(','e av SQG (Ail S3s7e s..,....1-
<br /> PHONE PHONE ❑Site Plan approval from
<br /> 6oc? aso 01 O S 9^^c- applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Lei f-
<br /> -Fre Cc9 Ast/o c 1-70m.co/►Z ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> El PARCEL /� frontage drawn to scale.
<br /> NUMBER S3%8/.z-332:005)-'3 !l -,Z, �•/Z
<br /> TOWNSHIP: med''s SECTION:
<br /> 7"o 8 NR /a F 33 y4: N F %4 : Al w ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> c3 r,'d'A. y L.. /11,,th A// t.. 2. S3S51' ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public, private)
<br /> �0// hSv//
<br /> PROPOSED PROJECT INFORMATION S AFP REVIEW
<br /> PROJECT DESCRIPTION:
<br /> //dCf 7 f16 rt 0 Zoning D�istnct
<br /> . ❑This project is a new building or structure. U Perm ittli Us
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE PERMIT NUMBER: - t6ra�tA dress ' -
<br /> EWER FEPTIC 0 I_'„!,r197: _:;.- - ;':, f.9
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) :. t
<br /> 9( _� Ian oo� aln'
<br /> °�T � o n� � rhent
<br /> '3
<br /> AREA TO NEARESTSQUARE FOOT: tv£v ,
<br /> (Outside dimensions including unfinished aria, attached garages and above grade decks or porches) „,,,,,**„.0444.11, -:,,-,;;,,,444,,�� 6 ; ;
<br /> ® S �tl3t) �0�+ l�TnitA"�
<br /> BASEMENT: 1ST FLOOR: °
<br /> 4, TOTAL SQUARE FOOTAGE: 4, r +° S,=a I ' !go,
<br /> a//)(g /9a s-f /7.2. s + «« -
<br /> 2ND FLOOR: 3RD FLOOR: /'4; 04 f 01 ,: x,:
<br /> ESTIMATED CONSTRUCTION COST: i e 1”.j + pip g a
<br /> (Please round to nearest dollar) : 6 X6-06 <-1 _ .,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ❑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? 2Yes 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#I,li2('4 L) ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes y! o ❑Don't know
<br /> 7. Is this to correct a violation? ['Yes r o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ♦ -► -►
<br /> 545-112(4/08)
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