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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER.INFORMATION ' ...
<br /> -••-�� -'- -' CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Veg.t .t.rt ii •m es L 1_�� 0 Zoning Status;CUP;
<br /> OWNER ADDRESS Number,Sir I.City,Stare,Zip) , Deed Rbstr tion;CSM
<br /> jQ (i0 1 V--'u - l 011)A-)Q. -` 14 �.CS( Yl1 W-17.-- 51 r3 Variance(# )
<br /> HOM PHONE CELL PHONE E-MAIL ADDRESS
<br /> 0., • 100 FGctrc:ei,L. Ve2;d 1 an 1•t, •s. COrn. ❑ Site Pl n draWn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION .. and inct4 s dimensions
<br /> AGENT NAME A E- CONTRACTOR NAME
<br /> S E A-S A BO V ❑ Site Plan in uding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of weil/k tic
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks/-
<br /> PHONE PHONE ❑ Site ��oval from
<br /> appii a .1 ship.
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> ❑ Floor planp.to scale
<br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dano.wi.us� ❑ Elevatiott//of r e
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p
<br /> frontage dr n to scale.
<br /> ❑ NUMBER ��cti ` �� jo i�\
<br /> TOWNSHIP: SECTION:
<br /> , rY4'k \,e T 1 b v ,/: ,/4,/4: ❑ Driveway permits
<br /> ADDRESADDRESS: ,, (state,county,town)
<br /> CSM: LOT F. SUBDIVISION
<br /> L � ll BLOCKILOT ❑ sanitary permits
<br /> (public,private)
<br /> D.
<br /> PROPOSED PROJECT INFORMATION a i vM' i .'
<br /> v � ..tom -, , s1� {
<br /> PROJECT DESCRIPTION h-.., r�4
<br /> 5 }�/ Q t zJ Carl r�c r 4 n ,U'c4.46r�.tiv: 4rtZ-
<br /> ,.,_,� �4ui z �rrf' � f
<br /> Ud'This project is a new building or structure. p -ae�A{rr .r,,
<br /> ❑This project is an addition/alteration to an existing building or structure. i':',,,::7_,--,-; , `�--a 'w r ,.` tir�4:•
<br /> SANITARY SERVIC PERMIT NUMBER: / /�` / l , ,rt-Ttf 1 ,.".. li:,
<br /> LJ SEWER ❑.EPTIC .. u..t C-- W 3 t0 S I� 1�(I�1. 41P Ce r 'i i���/
<br /> HEIGHT IN FEET: " 5 / , - NUMBER OF STORIES: (Not including basement) , r : § ":t* erl
<br /> St ,r14f i`I�,ta.,,t,r:?i-rKftl�'�T'!;r E 4
<br /> AREA TO NEAREST SQUARE FOOT; �, s + : ,s'!
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a',, } t r `
<br /> BASEMENT: �1 T/FLOOR: 4 w,t� 0 2 �" v,lv�.'k" r',1
<br /> 9 I / C/ -4, TOTAL SQUARE FOOTAGE: 4, .,, t a.. •'t, ED ,�_1,1t } 4n.
<br /> Cam" V ✓ !• `il PP(��.- y,+.a� 'L-v VI:
<br /> 2ND FLOOR: 3RD FLOOR: c til ,•.5 St T s ty 4 , -. x:?.e.:
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ J(�� / �'� UQ yt f 'r_jur ,kitti fill, le
<br /> Pfease round to nearest dollar 1 /`—( . ,.., „K i,�// u , k; ,�- ,.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a2/No ❑Don't know I
<br /> 2. Is there a wetland or floodplain on or near the property? ,❑,�,,Yes 1]No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Ui'Yes ❑No I
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes Ul'Ko I
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (lea a blank if none) I
<br /> 6. Is a location survey required? (see reverse) es ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ai'No F
<br /> APPLICATION MUST BE SIGNED
<br /> • (Continue on Back) -+ -+ —►
<br /> 545.112(41ots) r Q`�
<br /> VArel X4 S S-/V C7 I
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