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SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION: : °4.. �r CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> /0 hi, ki'L tit,4Lt., /14 o CI-4.`"' /4-(P«,,,,c,-r-far ) ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 44 6 33 1-1----(54.4/+ /33 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6„8- 73..—2-7SI vc,L1.., T E'- 1/-C4 t •'.✓ ' N'-r- ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME —� CONTRACTOR NAME
<br /> -J ;h .i 6--1 q-Nt S/c.✓ C0,1,04-.y ❑ Site Plan including location
<br /> AGENT ADDRESS - CONTRACTOR ADDRESS - of well/septic PA-
<br /> S-7 1? 7-C4M•4;d 411,j't- S//f 7?-141./ /C 61,�-'--1
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> at `" f 44,Li.v( £,Js S3 S$ 641`/=4,c,-,,,k_ Gv ,S1/.i Te
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 432- ?3'— '77F9 . 6°?' g...?8-77 Y51 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> �/LAdLtiI c._.
<br /> 'S •f.✓/1444,e,....,..., , c,,_'
<br /> >w ❑ Floor plans to scale ��
<br /> 0 4/4 r l ,/ •^Det.t1.. .Co.;...'
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) ❑ Elevation of ro ert
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y
<br /> ❑ PARCEL d frontage drawn to scale.
<br /> NUMBER U J/0 °a 7 L-k o oC - 1 L-2 1111 3,35
<br /> TOWNSHIP: SECTION: oi P4.1/4:_ l , , ❑ Driveway permits �/
<br /> ut�4"` 7—�—lo /.: Nwl //: coun town) h,
<br /> ADDRESS:
<br /> (state,county, )
<br /> X4.33. kkj4W.t-y /36
<br /> ❑ Sanitary permits /v/A„
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> ?`,3 ‘.9 /
<br /> .7�
<br /> PROJECT DESCRIPTION:
<br /> IN v/ -7.0.) b, A-Nc c./ l'yCo.J s'rf„J --43 4 ep Ggcxe. (__:"x/d 7°'%r 4;$41 i r
<br /> ,This project is a new building or structure.124,941 c-c4-w7' i t i'-u) 4'1' r
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> ti..
<br /> SANITARY SERVICE: PERMIT NUMBER: F '
<br /> ❑SEWER ❑SEPTIC /1/4- A/4
<br /> HEIGHT IN IN FEET NUMBER OF SSTO- S: (Not Including basement) :'
<br /> -AL ;Si ,J 111_4' A7 #1 o r A/ 4-
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) e e
<br /> BASEMENT: 1ST FLOOR:
<br /> TOTAL SQUARE FOOTAGE: 4 - 4
<br /> �I 1 3
<br /> 2ND FLOOR: 71-1.---
<br /> 3RD FLOR S/f s egb,,:c�r <sf fT f( �3
<br /> C, /st f, 0 ,1 0 3Y,. _ ,r
<br /> ESTIMATED CONSTRUCTION COST c� r--,`1 x ..- ( ")
<br /> (Please round to nearest dollar) '♦ --► "■ '4' ♦ '♦' $ .J Soo •�'�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,.,Vo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,,RNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Alo .-
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes
<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 lo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -
<br /> 545-112(4/08)
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