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<br /> ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT to Web•App#
<br /> PROPERTY OWNER.INFORMATION z,', „__=' 'T;' ;. t'sht.;:;: -=..-:` ,:?- CUSTOMER TO PROVIDE A
<br /> OWN RN•ME / )/
<br /> /d -e/-f - i-,--.4- �D n !%'' Zoning Status;CUP, V
<br /> -/OWNER ADDRESS A umber,Street,C,State,Zip)/ /� /y— 44„,/4'//' 074.-7 Deed Restriction;CSM
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<br /> �• /Y/aa'so", w-- , , 37/ 7 Variance(# ) /O./j..\.
<br /> HOME PHONE CELL PHONE E-MAIL//ADDRESS / C)(
<br /> 60 g' ,, 06- 39f b4/��,4 0C�il/ic ,ef ❑ Site Plan drawn to scale C
<br /> AGENT INFORMATION - t CONTRACTOR •; and includes dimensions • J
<br /> AGENT NAME CONTRACTO NAME
<br /> ,Oki./ 4/o 5/.5:5 /'s _Gil c_ . ❑ Site Plan inc uding location
<br /> AGENT ADDRESS CONTRACTORADDDRESS , of well/septic
<br /> 8 0/ /1� /174-/A/S T. --Sk i-/.c C v/ �t/. ,n4,,./57 S k c �'�Y;`�"�
<br /> (City,State,Zip), (City,State,Zip) .`35.5 ❑ Setbacks
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<br /> ' P ONE PHONE • 4 Site Pla proval from
<br /> 6.4p_ .5-7?-2— 3$16. aPPli le wnship:! Dk-c/1{f—/975
<br /> E-MAIL ADDRESS / E-MAIL ADDRff��SS
<br /> 0 -S,T/u,n,n �CN�'f-zC,,yer ia�(� i/1• "-U� cow., ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdene.co.dane.wGLEu.s/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CUR TZO ING: ACREAGE: P P rty
<br /> ❑ PARCEL frontage drawn to scale.
<br /> NUMBER D7o7-/Z�- 970- k/r=� •S g
<br /> TOWNSHIP: /9 SECTION:
<br /> (- r055 //A, j / Z '/a: e5 E %%: 5 E .4 Driveway permits
<br /> (state,county,town)ADDRESS:7957 /e"- u n Q //I• /'G SS Q
<br /> "I S,a/T C352;
<br /> Sanitary permits
<br /> CSM: B LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION
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<br /> PROJEC DES�CR PTION:
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<br /> This project is a new building or structure. i, tj � 7,
<br /> ❑This project is an addition/alteration to an existing building or structure. 1,'.1-'7; r
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<br /> SANITARY SERVICE: PERMIT NUMBER: �� ,
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<br /> ❑SEWER .SEPTIC 7o 1 c''�' e
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) s '" -q
<br /> 2 w 4 ; (®i i
<br /> AREA TO NEAREST SQUARE FOOT: g; H " t 0 4
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - :
<br /> BASEMENT 1ST FLOOR: �-Z 5" _. a�'�� �r� �E
<br /> /t 3 Z -�!a.4 i ,, TOTAL SQUARE FOOTAGE: ,, La r tx
<br /> 2ND FLOOR: 3RD FLOOR: j 7
<br /> /1s I/Jib
<br /> ESTIMATED CONSTRUCTION COST $ _ uv m� 9t�
<br /> (Please round to nearest dollar) "� _o. -+ $ I1 7 1 7 Z z, ?
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 25Io ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes gNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? gles Or lo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ID Yes l�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 ,Ll�o ❑Don't know
<br /> ��vJ,,N
<br /> 7. Is this to correct a violation? ❑Yes l`�No
<br /> 335
<br /> S�� '''' APPLICATION MUST BE SIGNED
<br /> 545-112 ta/oel 0,0 (Continue on Back) -0. -► -►
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