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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME n
<br /> _3;01,5 D /97i.- Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Stteet,City, 94 e,Zip) Deed Restriction; CSM Le L
<br /> 84� e k,, ,vi,n K. �0,,4// 2}z- ,_ -7f...9---. -?
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRES
<br /> a I/9-677P 07,-f irevb rl 644.0'/" Site Plan drawn to scale '
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT AME CONT CTOR NAME // t
<br /> r
<br /> o� 2c� �1 1ea/ ,4,,//-4.S �6r.,‘ IO�Site Plan including location 0 � n
<br /> AGENT ADDRESS CONTRACTOR DRE S of well/septic �T
<br /> anal �, fr,hio /90 a,�/ J/
<br /> (City,Std, ip) (City,�te,Zip) ,„Setbacks 6 j/" 'e/'/0
<br /> �I/a,,,; 1L .,10/9 f/e/.-1i26 , wr ,555,.E
<br /> PHONE PHONEite Plan approval from , /
<br /> �2)�-7 -43, Za- 1Y.S- ,,2 9 applicable township. /1 ,,
<br /> E-11L ADDRESS f E-M ADDR SS /
<br /> c�re e2 r6/e 0,, ��;)c/05,e zee "'a%°/7`0-4-v �n9"`°"� Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) it
<br /> PARENT PARCEL NUMBER: CU TZONING: ACREAGE: Ei Elevation of property
<br /> ❑NUMBER Dg//"/7,.715 .0 13 _zi 37/ frontage drawn to scale
<br /> TOWNSHIP: SECTION:
<br /> �,� �C I/e. /7 1/4: /) 1/41/4: ,t �' Driveway permi
<br /> ADDRESS: (state,county, • r
<br /> .:77il / De./' (1)e e Ai kA9 0a/J ro,ire, L>Z
<br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits
<br /> //,v,r/ / (public, )
<br /> PROPOSED PROJECT INFORMATION STAFF REVI
<br /> PROJECT DESCRIPTION:
<br /> 7�/1"- /5- Zit&)10rn� I ro5 1 1 / 4F. Zoning Dtstnct
<br /> []This project is a new building or structure. 7 2 15C1 0 / T A,,C pe [fled Use? J r
<br /> ❑This project is an addition/alteration to an existing building or structure. St`
<br /> SANITARY SERVICE: PERMIT NUMBER: RUra!A•• -
<br /> EWER EPTIC S (new -xlstin•)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> V1,5-/ /
<br /> IlLi - loodplain/
<br /> AREA TO NEAREST SQUARE FOOT: hare!-#: (attachment)
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> 1�.. .rosionControl permit -
<br /> BASEMENT: 1ST FLOOR:
<br /> r/�/ 1 TOTAL SQUARE FOOTAGE: + (slopes,,disturbance,
<br /> �v filling/access) ' �,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> .--� ` X5-/ Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: Q and available options. '
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ �, ,DD D
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes []No ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? [fYes ENo ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? [S'es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eac'es ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one)
<br /> 6. Is a location survey required? (see reverse) ❑Yes U'" ['Don't know
<br /> 7. Is this to correct a violation? ❑Yes Ilo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -+ -►
<br /> 545-112(4/08)
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