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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> �WNER N ME c /►
<br /> )JE "''acuS Te-r7 (cv-tAt krec --T MJ oning Statu nillito
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction SM
<br /> 2 �leiGyr a kxw, 5-a BLv� RM An l`IAD �,, t-J-- 537 p3 Variance(# I sa )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 6
<br /> e Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME A CONTRACTOR NAME
<br /> HA u ass 1aaPIRA r*,,/ J krc—c s G A
<br /> af.>;ThvGTt®A) 0 Site I Including location
<br /> AGENT ADDRESS p CONTRACTOR ADDRESS Of eptic
<br /> Zz/ 3EPfeesei.)Pt04L- fk'vy q'!`I f IfPGEtn/4r&12a1 4) _
<br /> (City,State,Zip) (City,State,Zip) asetsgks
<br /> 114uC4d■44I, VA ?�so 1 It'7,,4D1SCII, 1.. 53 ?/3
<br /> PHONE
<br /> • P oNE El Site proval from
<br /> �L1) L3 '—jz to ONE / - Y600 app' le wnship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> GciTZ 0l601AR2zf, CoK Sbn-ATr'C3t-i'e ba Astea o. coal oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) (,Glo„+s�;On of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Q.... 1 Ti P P rty
<br /> ❑PARCEL Ot` frontage drawn to scale.
<br /> NUMBER /txllZ'L?I-=f1l"�
<br /> TOWNSHIP: SECTION:
<br /> ROC lettilt Lri 1/4. 1/41/4. D Drivew rmits�
<br /> ADDRESS: • (sta ,cou ,town) '
<br /> l '!' S-r Ala f/Wy 73 Roret,A.cE, c„z s 3s a5- anitary permit
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,pri - e)
<br /> PROPOSED PROJECT INFORMATION ?' -4:„-
<br /> PROJECT DESCRIPTION: 1 E
<br /> &. The•1 Ae3 Sil'b l si a_ UP* 2G•O''� kV(4 Crtu+c C° c rs�v r�«,2P • 1 1 .'a 1'! a V4.14 0 project is a new building or structure.
<br /> ['This project is an addition/alteration to an existing building or structure. g r - ` 1
<br /> SANITARY SERVICE: PERMIT NUMBER: 4 " - '
<br /> EWER rEPTIC t�, ><, ' '
<br /> F� M 6Y
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,' .%'.
<br /> AREA TO NEAREST SQUARE FOOT: ,;:,,V,'' ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR: . 4
<br /> -�" Lela/ 4 TOTAL SQUARE FOOTAGE: + ( $". t°
<br /> 2ND FLOOR: 3RD FLOOR: 11
<br /> -,W°..11',' a - ,,
<br /> ESTIMATED CONSTRUCTION COST: - ,,,..,,,4,,,,--Please round to nearest dollar) "♦ -• ♦ -• -• -• $ /O, v,O t - ,,
<br /> :,
<br /> C
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes NINo DDon t kno�
<br /> 2. Is there a wetland or floodplain on or near the property? Dyes o DDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [Yes o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes DNo
<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) Dyes [ p■lo ['Don't know
<br /> 7. Is this to correct a violation? Dyes tato
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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