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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App #
<br /> w
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> 4NNE Tare C. "ORN EGC. ❑ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> yqa 9 �'6ENSTRA 1QQ. InAKS,v�000 & A-3559 -
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAILADDRESS
<br /> IA Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT ME CONTRACTOR NAME
<br /> 2,AN CIZI04.lei Y 410,27o N 0u14,0,Ngs Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 20 oox 3a v P,o 2o.11 3 L' �(
<br /> (City,State,Zip) (City,State,Zip) E Setbacks
<br /> .LXOH'4 432 S-3 o34 JXDN1p ,
<br /> 6-1r S3a34
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> Sao-a6/-9/57 9e90-a6/-4/5/ applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS ,,may
<br /> dr;av►,ereAajeI prt m°a4°"b143 ;'"`SS•4a",br;.,,„.Cr.a,wlvya-f mOr•"j. 13141d,5s'°9 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property
<br /> ❑ PARCEL p / / S" frontage drawn to scale.
<br /> NUMBER 6lp81d-331-'7/OO� / R`l I. ��7
<br /> TOWNSHIP: SECTION:
<br /> in 601 w4 1%: 14 1/41 ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> '/9a? /CE�NS'T)QJp � O. ARS N/OLG Gc>£ 5353-1 ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: S71*W- 0,! t
<br /> to
<br /> 30 'X? ' Pc' on.i / Silora�c. 4c e. 2G06. Zoning District -. f
<br /> This project is a new building or structure. J ; J� 7'
<br /> Permitted Use? ®
<br /> ❑This project is an addition/alteration to an existing building or structure. G S
<br /> SANITARY SERVICE: PERMIT NUMBER: Rural s,
<br /> ❑SEWER ❑SEPTIC
<br /> -'701-41-1',', 0410.09):144--..t=10,1,,.,
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> .horeIand 4( acjtmet )
<br /> FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,, ' ' ,,,,,,,,_ k.
<br /> BASEMENT: 1ST FLOOR:
<br /> ' Erosion Qrltroikeri IN
<br /> j TOTAL SQUARE FOOTAGE: + (slopes,distulrbance,
<br /> fillingfaccess .
<br /> 2ND FLOOR: 3RD FLOOR: 960,E
<br /> Review i=ocatian ti
<br /> Sr y
<br /> ESTIMATED CONSTRUCTION COST: ♦ ..+ ♦ ♦ ♦ ♦ /3,000 and available options ,
<br /> (Please round to nearest dollar)
<br /> ''''''t ';T LL
<br /> (3 )
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes �o ❑Don't krlo
<br /> 2. Is there a wetland or floodplain on or near the property? ,❑f(es L'i No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? le Yes ❑�o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L'9 No
<br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave bla,�nkf'�none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes alb o ❑Don,
<br /> t know
<br /> 7. Is this to correct a violation? ❑Yes 3No
<br /> /6 iri-° ` 't? APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) v
<br /> (Continue on Back) ♦ -►
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