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' ZONING PERMIT APPLICATION vIrww.countyofdane. om SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAM '/ / /
<br /> acif. /�- -s/"/ S,0,-4.r...,a c Ia L/ -4,- c
<br /> WNER ADDRESS (N ber,Street,City,State, _ ZOrling Status;CUP;
<br /> /" 2? 6>i--e-c",il,� j . / -102 z �'u�r�0�,�,,,,�, wl Deed Restriction; CSM
<br /> v Variance(# )
<br /> HOME PHONE CELL P ONE E-MAIL ADDRESS ��Plan drawn to scale
<br /> 8"37— /�4 G%-.2oy-394/2 i, @'"/- ,.o, c--`�c
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGE T AME NAME
<br /> �u0.I 4"4 e...__ S/`t"" - 1 S : -Ian including location
<br /> AGENT AD ESE �3aX 2-0- CONTRA TOR ADDRESS • ■-II/septic
<br /> /(City,�[ate,Zip) ' \1 (City,Stat ,Zip) 1 Setbacks
<br /> `v/
<br /> , e.,,,n /sOc r•'n W 7-
<br /> PHONE PHONE Ite n proval from
<br /> g37ô Yg �d9' 3892— appli township.
<br /> E-MAIL D RESS E-MAIL
<br /> ,« J e q c.),//3/..) cc.),-, c `�
<br /> loor pl ns to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y
<br /> ❑ NUM ER a 1 )I t3 i 1 S q t` 0 ' , -_ 1 a-C • frontage drawn to scale.
<br /> TOWNSHIP: SECT`ON: ❑ DCIV a ermits
<br /> R f • L( I S 1/4: N 15 '/41/4 S F (state, yunty,town)
<br /> ADDRESS:
<br /> - - el INI 6 A,,,,,,,,.-> ❑ San - sermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (publ',, •rivate)
<br /> PROPOSED PROJECT INFORMATION TAFF REVIEW
<br /> PROJECT DESCRIPTIO A / c '-/ ,:':,W:.,,,,:',,,g a
<br /> t
<br /> d� -$C._ W � � '"'�� �aning L�rs#rrct�
<br /> . gaihis project is a new building or structure. errnitted Use?
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUral.'
<br /> ❑SEWER ASEPTIC (n• existin€g)k
<br /> HEIGHT IN FEET: / NUMBER OF STO IES: (Not including basement) I
<br /> /— 42- etland*Ii56;604 f
<br /> ,.Shorefand (attachment✓)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT 1ST FL00 rasiorr ntrcl p ripit ,
<br /> N/A 8 S 4, TOTAL SQUARE FOOTAGE: j (Slopes,d sturb rnce
<br /> 2ND FLOOR: 3RD FLOOR:///4 fil(ing/✓access) �-1
<br /> �/ C ieview Location Sr in/ey
<br /> ESTIMATED CONSTRUCTION COST: dO
<br /> ♦ ♦ -♦ -∎ -i and avaitabte optrons
<br /> (Please round to nearest dollar) ��
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yes 21 No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the prop rty? ❑Yes ❑No aDon't know
<br /> 3. Have you talked with the township about your prof ct and are they in agreement? -Yes ❑No
<br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? j Yes ❑No
<br /> 5. Is this project associated with a rezone/CUP/varian a (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? CI Yes allo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ■ —► —►
<br /> 545-112(4/08)
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