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SUPPLEMENT:toWeb-App#;;
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION - `< CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> M A"tt M f ali" 6LZ Zoning Status; CUP; 6)
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM
<br /> A?t L'1)/ S�°Rr N� r L P I5P ;-3—S2 9 Variance(# /4 3�
<br /> 1
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 4 g i /A-7 'zi "--,f5"1 v4 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions' , e..
<br /> AGENT NAME CONTRACTOR NAME F�
<br /> Site Plan including locatiol 0
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) �j[� Setbacks 63/304 a PHONE PHONE '/ D�` site Plan approval from
<br /> l/ 1 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> 1,KI Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION ,(http://accessdane.co.dane.wi.us/),_
<br /> levation of property
<br /> PARENT PC N R: CURR TZONIN ACREAG �i �
<br /> ❑ PARCEL r Ii;:w360� X_ 2 [�� d frontage drawn to sc
<br /> NUMBER /
<br /> TOWNSHIP: SEC ty ,
<br /> p r 4 1, C / O. s'� , s'hi igl Driveway permits
<br /> ADDRESS: (state, count town
<br /> Set w
<br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary p- mits
<br /> �
<br /> _ (public,,• ,•PROPOSED PROJECT INFORMATION '� yf. STAF—Frie l..t
<br /> PROD T.,..FSCRI TION: )/ Cot / ` +- � V-='--. `,:%.,,,".r a.
<br /> p 3 0 /` 2 �, k 0 . C�oc$ , Lc Gil r ` ',�Onlrla 0 s .C rte�„!
<br /> i.., tip ". t,, -�
<br /> This project is a ne • :'n or structure.
<br /> I�// This project is a .dditio :Iteration to an existing building or structure. i T ;t- '
<br /> SANITARY SERVICE: PERMIT NUMBER: .ith % ,' X 1
<br /> nSEWER SEPTIC ' T ".t91 ' `
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ,R--11
<br /> ,:-S,horearaa ,, c-hrnent) 's
<br /> AREA TO NEAREST SQUARE FOOT r..r-'#', /
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - r = s
<br /> BASEMENT: 1ST FLOOR: '41T0Si 0 G o A 0 o er a cvz,F
<br /> �J D 4, TOTAL SQUARE FOOTAGE: ,, -s ,,, O o e `a 1 E a anc {z,
<br /> (/ F
<br /> y--Itiiii I6:Q .w 4 ;iC
<br /> 2ND FLOOR: 3RD FLOOR: , Y r
<br /> 4 t
<br /> �r r�kaE Nt3c r 1 o BI i
<br /> ESTIMATED CONSTRUCTION COST: $ 300 00 o1lC� o o: �--1 4
<br /> Please round to nearest dollar t -° �;:7 -, :;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 N El 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? EYes ❑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 n No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes 0 No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► -+ —►
<br /> 545-112(4/08)
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