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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID
<br /> OWNER NAME
<br /> c 1.--eid G p A pV Zoning Status;CUP; fr /
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 65 _21 Al khgtie-1 0 MA b2-54/`' i.✓1; 537 )9 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> )v4 Site Plan drawn to scale , )
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions �
<br /> AGENT NAM CONTRACTO NAME
<br /> K el)/cT' C n Si $I9P) i= ' -, ..: uding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS e --ptic
<br /> 3 0 8 M Lii / 5 SA r2
<br /> (City,State,Zip) (City,State,Zip) X Setbacks 3 o/�c/
<br /> G205S #L ,W/ S S Avn
<br /> PHONE PHONE D6ite Plan approval from 1l
<br /> 7 Gl / 77 1 s J) J applicable township. Iv,it-
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> - e✓" Gan P 1 40 f�a 1 A ' i& 4, - Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) f
<br /> PARENT P R ELNUMB CURRENT ZONING: ACREAGE: levation of propert
<br /> El PARCEL / ._ ....2 2g�� G 2 frontage drawn to -cale.
<br /> NUMBER Ell!!! V
<br /> TOWNSHIP: SECT O • N 14.1 M bO L�e'7Q 1/a: !W E -1/41/4: X Driveway permits A!
<br /> (state,county,town) "
<br /> ADDRESS:
<br /> �Sz Z N i rN < L A tie_
<br /> 1'_
<br /> Sanitary •- .5-- &$I
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public -
<br /> PROPOSED PROJECT INFORMATION .'STAFF REVIEW y
<br /> PROJECT DESCRIPTION:
<br /> 'Zoning District /.
<br /> . .. 0-This project is a new building or structure. 71400,- : ')'3' ',,,,-,
<br /> p j g Permitted Use?S '
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: �l ` R �4ddress a
<br /> ❑SEWER SEPTIC 2 `+ 3 w t existing)w �'� r
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> ,Vvettancf/Floodplain/
<br /> horeland (attachmen
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) P
<br /> ErostonControt permit
<br /> BASEMENT 1ST FLOOR:
<br /> �Li j, TOTAL SQUARE FOOTAGE: , (slopes,disturb- Cep
<br /> .?,3 G1 r 3 3 fil(ng/ac' ess)< M
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> C 9S -. --, „ ",N1:,'"." .;:i0,6",.-7--= -' ,t,,,,,,E,,,,
<br /> k.,,,:,Review Location Survey A t if_
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ Y 2 ©, 11001 0/' and available options
<br /> Please round to nearest dollar) V
<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'? ❑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 ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -* —►
<br /> 545-112(4/08)
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