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06/16/2009 09::iki b17U-1b/—J. 417 LUNG �,U rLt•11wvtrvu 1-P-1,...1 VW 1
<br /> SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> AuN N 1\ A,( •L( SP\ ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State.Zip) Deed Restriction;CSM
<br /> •o 6 (ock NI TY t4 Y 7- Variance(#. )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 24¢.84co ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> W A-L-re xs c,..--/.L-Q-1_,..3&....s ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,Stale,Zip) ❑ Setbacks
<br /> AU_t'iNc rdcY c_w 5300 z
<br /> PHONE PHONE O Site Plan approval from
<br /> q z . 6 5 S- 2)7' f applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accesdane.co.dane.wims/) O Elevation of property
<br /> PARENT PARC L NUMBER: CURRENT ONING: ACREAGE
<br /> ❑ PARCEL G frontage drawn to scale.
<br /> NuMPE,R os-0/0611-- 'z3-cls6S-D C -z Zc
<br /> TOWNSHIP: SECTION:
<br /> TvLvN o>, �Tir( P!ZA&Ic 32-2,-1I 1/4: Se '/1/a: SL' ❑ Driveway permits
<br /> (state,county,town)
<br /> ADDRESS:
<br /> 14o 6 £ c C'i r ' (-4 w Y 1-1—, O Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> I 2.3 3Z LOT t
<br /> PROPOSED PROJECT INFORMATION "`t ���" ���s.4 'i[' ';�
<br /> :x lic,,1`::' ,1i� Al'j .tl:a.li
<br /> i is 1'i i1 G..-,. Iii;i:k:!fi.,.. '�li a.i.
<br /> PROJECT DESCRIPTION: r`' '� �•. ��. :i��,I�'a �� .��
<br /> 5 ' )' 7 2 1 /` (6 f •Q( 0�-1L 01./00 0i1il ..W.I �' ....;.-.;iR I11h.IN
<br /> ❑This project is a new building or structure. • i' f;.: ''l 1';R5i,: ' '``'
<br /> This project is an addition/alteration to an existing building or structure. :',.;;4:4, ;`'`'' ,.-1. 1 ; ;�,; ,.`'`,e,
<br /> :: J i,'i % ddx;.�tvi•I k rd >:.�
<br /> ,I, ( 1 ..y �1�1.1`.1,•III fuli�•Ad
<br /> SANITARY SERVICE: PERMIT NUMBER: :,.I ,�t r ,I-'1,. tr. W;,S,
<br /> 121 SEWER C)SEPTIC x;: (1e . �1 ").:,;u,f'
<br /> ';',,�'v , ,.
<br /> HEIGHT IN PEST: NUMBER OF STORIES: (Not Including basement) ,��,�-1, •;I t••`,"• c [1,,,.�,�',It"�',,.,,,j>;,
<br /> j I G A•-LC d NI t- ';'ual,i etistii 1 a da Ir•.Y�:.y�li'y�':'
<br /> �1 ,,.., ..,i'li, t Il:i ?v
<br /> AREA TO NEAREST SQUARE FOOT :;�r; i i:::ti7.i , d'1t,Mry -:I�,, 'i,►I,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches �,d'^ i ^"f !;°I°nI•' I:;y: I . A qn�!
<br /> BASEMENT: 1ST FLOOR: : ': ,,�y '`�n K.'.*
<br /> 4 TOTAL SQUARE FOOTAGE: 1, J'��"ii"i; ,,._,. ,1`Qf3, "- ;a=r"I p ; I'J
<br /> 3RD FLOOR: j' �; J 17>"1:
<br /> 21C FLOOR: �..� '..1 4..,....�,,._ ��� �tary'r.',_.
<br /> Y.'f l�'..�'.1 9�i-,.,.JS:.-F,1.:.t .I'1�a N--f"r
<br /> ESTIMATED CONSTRUCTION COST 4 ` y 1", ,`. ?''1;�
<br /> y,M,...., li-1.,:1 t i a I
<br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ -P, -. $ Z_. COCA v 'i:> tit ; �ir�l 'r n. 1)ti t!�',�.1l .,
<br /> / .rid:: :+1:.7:. cAn.Ft,.-Id•«;i•:i[:V'xli:ya,_146�4��ath�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? O Yes gl.-No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ta No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? .." PYes ❑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 0 N ❑Don't know
<br /> 7. Is this to correct a violation? 0 Yes ,No
<br /> / L719/ z71 7 0 APPLICATION MUST BE SIGNED
<br /> 2/0 90 (Continue on Sack) -► -► -i
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