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SUPPLEMENT to Web•App
<br /> ZONING PERMIT APPLICATION viww.countyofdane.com
<br /> PROPERTY OWNER INFORMATION , CUSTOMER TO PROVIDE
<br /> OWNER NAM• k e vw & S 401 e- I� C —/ ( ©PPe
<br /> OWNERADDRE� (Number,Street,City,State Zip) �- L� Zoning Status;CUP; Z Z f
<br /> 1 5 ! 1 / / V,a ) }/D �'"� '' � Deed Restriction,. CSM )
<br /> 4N-1- KS A vt l ( UPI Ores S 3j Variance # 34 0
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ,,C4 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION _ and includes dimensions S ii.,
<br /> AGENT NAME CONTRA TOR NAME
<br /> Ki Site Plan including location
<br /> AGE.TADDRESS CONTRADTOR ADDRESS of well/septic
<br /> (City,State,Zip) ' C S i(n /323
<br /> •(City,stag,Zip) Setbacks //O©
<br /> PHONE PHONE i Site Plan approval from
<br /> applicable township. N/4
<br /> E- ; ADDRESS E-MAIL ADDRESS �( l
<br /> . d J Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (littp://accessdane.co.dane.wi.us/),_P• p` Elevation of property
<br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: ` p P nY
<br /> ❑ PARCEL 119i/ 12.. 9'� 7 0 _ ' /, Z r frontage drawn to scale.
<br /> NUMBER U
<br /> TOWNSHIP: SEC ION
<br /> Dv- , S Z $ r ,Y4,/: 5 f.---, El Driveway permits
<br /> ADDRESS: Szt_u.... (----
<br /> 6 22_ 5 F/de.v- G_e,,_ ,
<br /> NI CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits j 3_ r
<br /> 3 (g 3�0 / (public private,
<br /> — S–n0
<br /> l / 3>p
<br /> PROPOSED PROJECT INFORMATION -2,-0i:14
<br /> P JEC D CRIPTION: ST x rtt
<br /> )� 4- S pp Q 13 f / �y ' ;onmg D sly
<br /> ❑This project is a new boil or structure. Ts( L/ G✓ v. 5 - `'r»i -'e - 16 ' a
<br /> t se , u a
<br /> This project is a ddition/alteration an existing building or structure. Y: i�m„4,--:r.� , ,,,
<br /> SANITARY SERVICE: PERMIT NUMBER: /� � 1,- 4" "'``
<br /> pi SEWER SEPTIC / ? " d66� e ... . tea=
<br /> � ve=t is
<br /> HEIGHT IN FEET NUMBER DF STORIES: (Not including basement) .1.0'44-, �1� � { $� } --
<br /> . horeancF rc'hrnent)fi A
<br /> AREA TO NEAREST SQUARE FOOT: ,, h' u
<br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) ' 0 °
<br /> BASEMENT: 1ST FLOOR: ' q � �Sl�n{�"�sOI3 o e � ,
<br /> /0 4, TOTAL SQUARE FOOTAGE j, ,-4 r3-;e-
<br /> oe Xiis i ear]C '1,-7,,,--1:-..;"
<br /> 2ND FLOOR: / 3RD FLOOR: `i,
<br /> ti K ,
<br /> % �'`` i'1.Ear®a°f; I -11 "*'
<br /> ESTIMATED CONSTRUCTION COST: ] a�.7'a�1.
<br /> ( ) •"i ♦ ♦ ♦ ± ♦ $ 1 s ,.�.° r Fty '"
<br /> Please round to nearest dollar O ��-.: :�,
<br /> 1. The property is within 300 feet of a stream or 1000feet 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 ❑No ❑Don't know
<br /> 3. Have you talked with the township about your prof ct and are they in agreement? ['Yes ❑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/varianee (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 ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -+ --► -s
<br /> 545-112(4/08)
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