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<br /> ■54- tea- -,S
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY.OWNER s.INFORMATION z`_ ?;';_.'. w ,i-1. ; ,..r,;: `'6-11:2"-IS CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> ON
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status;CUP;
<br /> Deed Restriction;CSM
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> CnA C5V7 '� 4` Site Plan drawn to scale
<br /> AGENT INFORMATION :: ; CONTRACTOR'INFORMATION: and includes dimensions
<br /> A NAME CONTRACTOR NAME
<br /> VI i
<br /> 11 i :AA L. V m,0" } t 1 - VI L°) _ $ A Site Plan including location
<br /> A NT ADDRES r. CONTRACTOR ADDRESS II of well/septic
<br /> (City,State,Zip) (Ci.l State,Zip Setbacks
<br /> • •
<br /> 1__'. V Z , j'
<br /> A ,/d4 11
<br /> PHONE ��
<br /> D�_79����� PHONE ■ 'e P - approval from
<br /> �P 62Ce-79e'5/4 q 7' ape' -•letownship.
<br /> E-MAIL AD•RESS ff EE--,MAILADDR SS //?
<br /> ' ! I l Q L • ' "/y dr�� as ris,Y4%- ' Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION .:(http:1/accessdane.co.dane.wi.as));
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: A'` Elevation of property
<br /> NUMBER
<br /> C� q /I3 p`7� — I —] 6 frontage drawn to scale.
<br /> TOWNSHIPnn SECTION:
<br /> 0-)I',S"4 1 3 n ,A: S w Y/,/. S w Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> G __3-1 �-R f RN Tr 1 '� Sanitary permits
<br /> CSM: LOT / C.SUBDIV IO BLO K/LOT
<br /> _ ) , ; (ft:' ( 6�t44-4� (public,private)
<br /> l�
<br /> PROPOSED PROJECT INFORMATION, r' I -i-
<br /> PROJECT DESCRIPTION: a
<br /> ,p'1,This project is a new building or structure. �`
<br /> ❑This project is an addition/alteration to an existing building or structure. cryt ---,.,;IM
<br /> SANITARY SERVICE: PERMIT NUUM E "„,:,,,,,,,,,1„6.....„4,14.,,,
<br /> ❑SEWER ASEPTIC S1 S U ,:,� v - x � ��
<br /> HEIGHT IN FEET 1 NUMBER OF STORIES: (Not including basement) r :r__,, , ,., ..,.__ ,_1,...,,..._ .:,,,_?_;_4` `
<br /> AREA TO NEAREST SQUARE FOOT `
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �, i:fiq
<br /> BASEMENT: 1ST FLOOR: , e °� ®-s
<br /> 1 q L' O 4, TOTAL SQUARE FOOTAGE: 4, e , :m w -
<br /> 2ND FLOOR: 3RD FLOOR: ;
<br /> Li 9614 etiA.,,--,----',- - ` , -, '., --,.;I,
<br /> E N ic., ,-°{, •j
<br /> , ,z Y ESTIMATED CONSTRUCTION COST: � ..4. ..+ ..4. Lf ( � � g i� ,, a(Please round to nearest dollar) a ,
<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 /> 545-112(4/08) (Continue on Back) —0. —I —0.
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