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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER..INFORMATION; '. ",Y t_? ' '> ', -, CUSTOMER TO PROVIDE
<br /> OWNER NAME •
<br /> IOCNS c \ V- - ( kM ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) r Deed Restriction;CSM
<br /> 1 s2 DCo�Cc..r..t �a 8\ .),.$1•1/41:11-. \ \ 535x9 Variance(# )
<br /> HOME PHONE = ' •NE lwoc K) E-M DDRESS
<br /> 2 04 ❑ Site Plan drawn to scale
<br /> i —al �0 _ .fin • �• @. . ��
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) LI Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION ,(http://accessdane.co.danewi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> CI PARCEL n\A _ \ 3 A frontage drawn to scale.
<br /> NUMBER ��6fjo612o�3- ,at ,\ y
<br /> TOWNSHIP: SECTION:
<br /> •Q. c,1 ST S'NNW., Oql '/.: 3\4 %IA: o t, ❑ Driveway permits
<br /> ADDRESS: (State,county,town)
<br /> i - 0\XI\-\\-01-\ ,\1 535 ❑ Sanitary permits
<br /> CSM: L BDIVISION BLOCK/LOT
<br /> 0%\'l 2 L 0\ \ (public,private)
<br /> PROPOSED PROJECT INFORMATION 1r,7- .P`� rt, ra ,u, ,,
<br /> PROJECT DESCRIPTION: . '
<br /> Q This project is a new building or structure. 4
<br /> 1 ,.
<br /> ❑This project is an addition/alteration to an existing building or structure. 'j'
<br /> �, �i. 4
<br /> SANITARY SERVICE: PERMIT NUMBER: lf A • is E -viol P: ,
<br /> i ui b, i #t^`
<br /> i❑SEWER ❑SEPTIC
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> r<_. 1 L h; srL'! ' d b. f.,le n', if r d 1
<br /> Ifr'k 2,:,d r.�Sf cr ,, I.,(-j74 ,:
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i" ji .. 'I,
<br /> BASEMENT: 1ST FLOOR: -r' ......p.p( ..lhr... it . 1
<br /> 1 t 4, TOTAL SQUARE FOOTAGE: j �ti F �� R73:f r rr t,,, ,
<br /> 2ND FLOOR: 3RD FLOOR: s �'jllr�aY �I
<br /> . r ;
<br /> 2. • 4 ,aid `iYj, g_C r
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -4. ♦ ♦ .: y4'V1"bl - :- '.:,r a,-: 3kr-1
<br /> (Please round to nearest dollar) ' 3 000) _ j
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes E 'No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EtNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0'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) QYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes [ No
<br /> t ��` J APPLICATION MUST BE SIGNED
<br /> c (Continue on Back) --0. —► -+
<br /> 545-112(4/08)
<br /> Og
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