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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> OWIt (�e \)s )1�
<br /> R�IDDRESS (Number,Street,City,State,Zip) Deed ng Status;CUP;
<br /> Dee Restriction; CSM
<br /> 3 Q / 0 avJ042.So, p ire--11V)0N0) S 3-7/ I Vari ce(# )
<br /> HOME PHONE CELL PHON E-MAIL ADDRESS
<br /> -' '/I er:=. • 4 L C o,,., ite Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFC:iMATION and includes dimensions
<br /> AGENT N1AME CONTRACTOR NAME
<br /> ��� 0,r 3;1%r1,50 . /')t`✓SP 1) 40/S ❑ Site I ' eluding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of s ptic
<br /> Q. .`'1 VY-)0v'st a d
<br /> (C�State,Zip) (City,State,Zip) Setbacks
<br /> ONA44 --e t„J f 5.% 5 5
<br /> PHONE PHONE n ap royal from
<br /> Cc)q."7Li 5-- SgD appli township.
<br /> E-MAIL AD RESS \ ^ E-MAIL ADDRESS
<br /> -' -v. o dOA) oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Ele '•n of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑ PARCEL .- C fr• drawn to scale.
<br /> NUMBER �6)(J X 0 .-)11 5
<br /> TOW HIP: SECTION:
<br /> ny, S 1/4: NV/ ,/4,/ ❑ Dri -w- permits
<br /> ADDRESS: (st ,county,town)
<br /> CSM: LOT SUBDIVISIONt BLOC OT ❑ San -r- permits
<br /> 1r4twbe5°- Lear—k\ ) 1 (pu. . private)
<br /> PROPOSED PROJECT INFORMATION 1 ' ftevigOr
<br /> PROJECT ION: ,
<br /> . ❑This project is a new building or structure. "
<br /> erltEed use
<br /> [This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERM ITNU E aR ,€ °#' . ,), ,.,:..,/,,,BF r
<br /> SEWER nSEPTIC (new °
<br /> HEIGHT IN F ET: NU E F TOR ES: (Not including basement) '''!
<br /> e t '. .a..plain/
<br /> AREA TO NEAREST SQUAR FOOT: ; , y,y yy
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR: Ero . {
<br /> 1 1 + TOTAL SQUARE FOOTAGE: ,+, (slopes.disturbance,
<br /> "/ mi access)
<br /> 2ND FLOOR: 3RD FLOOR: )-1—/ }
<br /> r i5 ';11=4,,,,, -'t'',410,,,� y
<br /> ESTIMATED CONSTRUCTION COST: Q� /
<br /> –0 –0 ♦ ♦ ♦ 1 !/ tcii eve able
<br /> (Please round to nearest dollar) $ ,s.�- -40 , ,,:4A(
<br /> 1,2S'
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? I Yes ❑No ❑Don't kno
<br /> 2. Is there a wetland or floodplain on or near the property? !Yes u No ❑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 NNo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none)
<br /> 6. Is a location survey required? (see reverse) -Yes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑�,es No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back)
<br /> 545-112(4/08)
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