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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web7App #,. •
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<br /> PROPERTY`OWNERp1NFORMATiQN, ;' ;�; , ; , , �3 ) +., .4 ,s ; ., ,,.-,"p's CUSTOMER TO PROVIDE
<br /> OWNER N E
<br /> S `Cer ` Zoning Status; CUP;
<br /> OWNER ADDRE (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 8.S D 1 r 1%%)-, . '1 ` Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> .o8 -doW7_70 90 Sc,,, � . Site Plan drawn to scale
<br /> •AGENT'1NFORMATIOti1 V',-N a '4[0:004010, INFORII�1 TlO = and includes dimensions
<br /> AGENT NAME CON CTOR NAME
<br /> n �, <c h./ &'u-vL� Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR/ADDRESS of well/septic
<br /> (.,)30 /0 S Q cU 4)3jo '- S' C2,----( Ovi s
<br /> (City,State,Zip) (City,State,4.10) 1 J, Ti Setbacks
<br /> (13s,
<br /> PHONE PHONE _ Site Plan approval from
<br /> 47c) .- a D C vK32 CoO —.2Z S'vy3 - . applicable township.
<br /> E-MAIL ADDRESS. E-MAILADDRESS •
<br /> w. < � c"...---._?_.. I I Floor plans to scale
<br /> PROPERTY/LOCATION_I FOjtI�AA' LOM �:(httpa%aecess.ane co,Pan' �Ari uI� ' .
<br /> PARENT PARCEL NUMBER: C') l(„)? CURRENTZONING: ACREAGE: f I Elevation of property
<br /> n PARCEL `'�dijossiree NUMBER 3 frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> 3:,,,a /:9 %a: '/a'/a: n Driveway permits
<br /> ADDRESS w �� (state, county, town)
<br /> � o $2, //;7 P)- •'-Ft� Ti Sanitary permits
<br /> CSM: LOT SUBDIVIypION BLOCK/LOT (public, private)
<br /> PROPOSED PROJECT:INFORMATION STAR=REVIE�N _
<br /> LAS 4 y
<br /> PROJECT DESCRIPTION: -I T•Iig
<br /> (3 a (t0 . ❑ Zoning Dish ct a 1;
<br /> ❑This project is a new building or structure. U Permitted_Usee a ti
<br /> This project is an addition/alteration to an existing building or structure. 5 tx ''2 j f4,
<br /> SANITARY SERVICE: \,� PERMIT NUMBER: F❑.�F�tral Ad�de s5
<br /> FEWER TEPTIC 6 �X+T1E11K�13 flk-j� r2 •4*
<br /> HEIGHT IN FEET (' NUMBER OF STORIES: (Not including basement)
<br /> - rte. -r
<br /> . i d Q Wet6611Fo � ln
<br /> = .
<br /> Shoce7arrd attac r e )£�
<br /> AREA TO NEAREST SQUARE FOOT ey "*-^� r -""*
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) s
<br /> BASEMENT: 1ST FLOOR: CASISonrs�I pertlt�u
<br /> • }n ,^ i j TOTAL SQUARE FOOTAGE + ` S1CT}3ES �t3StUTU t gig a.",,,,,
<br /> Y t0 �2 0:10:1 -6111;191?.-
<br /> ry c�1 " x e,:
<br /> 2ND FLOOR: 3RD FLOOR: c ;c- x�`- .�, x , 1-,>r
<br /> 1 Rv 6: i Latin Su e -T❑ e at o _
<br /> ESTIMATED CONSTRUCTION COST: - - 16�'�'' " `'�'t
<br /> —► .-► --► --► --► and aaaEiiep runs; r
<br /> (Please round to nearest dollar) �� its a' ; _
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes QNo ]Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Res rziNo Don't know -
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes QNo •
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I 1Yes 1501No
<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 ` No EDon't know
<br /> 7. Is this to correct a violation? nYes to .
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<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —s
<br /> 545-112(4/08) .
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