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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION
<br /> OWNER NAME CUSTOM • PROVIDE
<br /> ((`''��`���' f-ik
<br /> WNER ADDR SS (Nu banree City,State,Zip) A Zoning Status; •P;
<br /> --• '-= ion; CSM
<br /> 9,12 $' /fro(4 mad 5,- Sri,} 6 Ch.'G 4�0/D-, CO 6 57 _ Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6 Site Plan drawn to scale t 20,
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions I X
<br /> AGENT NAME CONTRACTOR NAME
<br /> &i&de. Cr-Jr;)4/14.4..i-;101 4 .,c< <vrSNa...�I-.'vti 64 Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic r�.
<br /> ‘2 -Aziko}p1�c 5+4:+x- Zay ze12 r'7*.rkc.+-t c- di: 5,1.4c 7y 2lj 30 1815 L
<br /> (City,State,Zip) (Ci ,State,Zip) •Setbacks / l
<br /> ►4-74.x.>07, wT 53711 es,,,,�~iar-, l,.r 5 3 l)g . I f t
<br /> PHONE PHONE 14Site Plan approval from!J\j 4-
<br /> Z7,-1Geo E-A4- 1,5 applicable township. "'
<br /> E-MAILADDRESS E-MAIL ADDRESS i
<br /> El-/o/ cr c,7 , encor>`4��ld ij�oe2 . Floor plans to scale ��/
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property 7
<br /> PARENT PARCEL NUMBER: CURRENTZONIyp: 1 ACREAGE: P P y
<br /> li PARCEL Q frontage drawn to scale.
<br /> NUMBER oe O$ 3035352- /„- 1 pr- 53/i t, 2 g �/
<br /> TOWNSHIP: SECTION: i / �,�(
<br /> �j�6 r1p�',�,f 12 "3 0 1/4: S i 144144: S `� It Driveway permit
<br /> ADDRESS: (state,county )
<br /> 7g 1 2- Fume) P€20,3- +1 2 XSanitary permits c 1 / Q
<br /> CSM: LOT SUBDIVISION BLOCK/LOT IP
<br /> (public,private)
<br /> r5+k1w07n Pan•
<br /> PROPOSED PROJECT INFORMATION ;STAFF REVIEW
<br /> 4 v
<br /> PROJECT DESCRIPTION:
<br /> 'V -"-- 5;,9,/c Fq,m;17 Irw o W Co V 6 ri SGr Po or Zoning fDistrict . ;
<br /> . U•This project is a new building or structure. Permitted Use? ,
<br /> ❑This project is an addition/alteration to an existing building or structure. `d, ,„_. , ,,,,,,,.:;„,,,,,,,,:,,,,,,:....,., .
<br /> SANITARY SERVICE: PERMIT NUMBER: XR- I Address i4,: s -=
<br /> e lexlstin r(,J
<br /> ❑SEWER SEPTIC ( 1x ` �1!
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ��
<br /> 2-G .1 i We ®• toodplatrt! a '- X i
<br /> AREA TO NEAREST SQUARE FOOT: + oreta ® tt(chmen), C3
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR: �CQS1flE1�GOrtF03Ef111 1
<br /> Zoe,-g of __/' 33 eO
<br /> 4, TOTAL SQUARE FOOTAGE: j (Slopes,disturbance,
<br /> .Elm .! flilingfaccess)
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: R VCe1l,,LOCato options,.s.ey(Please round to nearest dollar) '♦ '� ♦ ♦ "♦ ♦ rj �� QdGs oo avadabte optlorts it/A_
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 0 Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No
<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? ❑Yes allo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) —► —►
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