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°SUPPLEMENT to-_Web•App:#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER:INFORMATION . ` �_, . •- r CUSTOMER TO PROVIDE
<br /> OWNE NAME
<br /> A/a4''4' C44.-c_ ❑Zoning .tat UP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> Deed R riction; CSM
<br /> 2(4 i G Ca%...yv,-„_ V 4'e.N 4 I�Pno✓vr' 533--?i Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6'0e,630 IftO la Og Le,riLez-
<br /> AGENT!INFOR(VIATION '' ❑ Site Plan d n to scale
<br /> ;, � ;CONTRACTOR _I.NFORMATION �;- and inclu es dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> /&LAC-E ,'det 9., 4.,,,J ',9.--S r f ❑Site Plan i5,06ding location
<br /> AGENT ADDRESS CONTRACTOR A DRESS of well/ tic
<br /> i 1L/ Vaal //c..r7
<br /> (City,State,Zip) (City,State,Zip) ❑SetL ks
<br /> if rtl e w" 5-3 5-4„ L
<br /> PHONE PHONE ❑Site Plan al fr.m
<br /> c* S16 /t+-o applica ' • ip.
<br /> E-MAILADDRESS E-MAILADDRES
<br /> 0 - ^ f'e1..r,Pae9i. ..) r4o. 'c, rti.►Gxsr. .Gu IA I Floor plan cale
<br /> PROPERTY/LOCATION.,INFORMATION-] (httpN/accessdaneco,dane.w,.us/)
<br /> PARENT PARCEL NUMBER: .- CURRENT ZONING: ACREAGE: ❑ Elevation perty
<br /> El NUM ER 01001 O// ?DO) Z 4-r frontage dr wn to scale.
<br /> TOWNSHIP: SECTION:
<br /> •Stoo l p gr,e. %a: '/a'/a: ❑ Driveway permits
<br /> ADDRESS:
<br /> (state, county, town)go .
<br /> 61,A„4 44,,.1.,r
<br /> CSM: , LOT SUBDIVISION BLOCK/LOT El Sanita per S
<br /> / /
<br /> S S�9r� `
<br /> (public, ate)
<br /> PROPOSED PROJECT INFORMATION ', ' s 1STAFFTRE 1N g•
<br /> PROJECT DESCRIPTION: t -5 I n
<br /> : :
<br /> III. his project is a new building or structure. fi0 Fermin see E _ 4.
<br /> •This project is an addition/alteration to an existing building or structure. t r � a `-
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> © R �l Add ess t : '£ I
<br /> EWER FEPTIC /3 — to' ce " 000,y , ex tit } 4
<br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) a�; -- ` ' ".i'7,7-'1,::;=:3.1--.:::.:-.1
<br /> •� ` / Qa1Nela Ff?7 taint ui,
<br /> l Ti,Shore attar ltmaept) :
<br /> AREA TO NEAREST SQUARE FOOT s ' ;
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - . -:�._ r
<br /> "Etc eZ -o,to .mit
<br /> BASEMENT Q 1ST FLOOR: .� -
<br /> /'V/•co �4:29k ' ,, TOTAL SQUARE FOOTAGE 4, SlD:.-'\-.5,e �? ;* '
<br /> Jim , a,�
<br /> 2ND FLOOR: 3RD FLOOR: 5 /e. '�'� -" ,' P.ee � s -
<br /> C� f :e diet/=L® att n Sur' ey z
<br /> ESTIMATED CONSTRUCTION COST: ( _�l — ' oo
<br /> (Please round to nearest dollar) ♦ '"'� .♦ ♦ � '♦ $ y/ J t7'C>-v � � ab� p i3t S� --
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,171IVo.• ❑Don't.know
<br /> 2. Is there a wetland or floodplain on or near the property? Elves Clo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ,ires ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eves o •
<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 ❑Don't know
<br /> 7. Is this to correct a violation? Elves ,lallo
<br /> - APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4. -.0 -►
<br /> 545-1120/m) • -
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