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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NE ';
<br /> ChfiS ( (3,, / , ( t C. 4C T
<br /> �' �""' ❑Zoning Status; CUP;
<br /> OWN DRESS (Number Street,City,State,Zip Deed Restriction;CSM
<br /> 666 ot /6'65 C i ICI /( Variance(# )
<br /> HOME PHONE CELL PHON E-MAIL ADDRESS
<br /> •
<br /> I i .Z - Y C) C &t,'s f.,1' allot s ,le- ❑Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME//'�
<br /> T e"'d "t U--//re..5 ❑Site Plan including location
<br /> AGENT ADDRESS COI jiRpG'[OR ADDF�E$S 4 �� of well/septic
<br /> (City,State,Zip) (City,State,Zip) N(J ❑Setbacks
<br /> WOG AK(1ef ti■r--
<br /> PHONE PHONE ❑Site Plan approval from
<br /> 7-.2-0 - 7 gy( applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑NUPARCEL MBER og 0 ,-6`(—80601 frontage drawn to scale.
<br /> TOWNSHIP: SECTIOf N:
<br /> ,( 1/4: '/4'/4: ❑Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION STAFF„R VIEW
<br /> PROJECT DESCRIPTION:4A O(Afr^C 54 N L oningDistri
<br /> a - ^
<br /> • E This project is a new building or structure. itt U e? 0 � '
<br /> e tit Use 7, x'
<br /> ❑This project is an addition/alteration to an existing building or structure. t , ,, t i3;
<br /> SANITARY SERVICE: PERMIT NUMBER: �e 5 ,�
<br /> EWER FIEPTIC r �'
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) ( w V t-r
<br /> W; • + p
<br /> o • d1� ent r,:
<br /> AREA TO NEAREST SQUARE FOOT: %, , .•
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) L ,., ,..,.:2:4,..„01,14:4�'
<br /> BASEMENT: 1ST FLOOR: A,,,,;,::::,,,,,.6.� a
<br /> j, TOTAL SQUARE FOOTAGE: + , rik- ;6 • ' .= ( ,b
<br /> r .r
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> � " C '
<br /> rR i.n ray
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ --► '' all iv habit~optiopo spa,
<br /> (Please round to nearest dollar) 3 4 d _
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EiNo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Dyes 2lo ❑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? ❑Yes &Jo
<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 EINo ['Don't know
<br /> 7. Is this to correct a violation? Efres ONo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -►
<br /> 545-112(4/08)
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