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SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION` CUStOMER TO PROVIDE
<br /> OWNER NAME
<br /> Po iz 0TH' IY esv.E (9/Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) MC-F AveL,ft 2 I W ( Dejd Restriction;CSM
<br /> 32-9 S LE E So o-c't-t C-T.. 5 355$ Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS /
<br /> 2-35 - 7 3o 2. LIVSite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> CHR.t-S rh tL-1—Cs2 Co-J,ST. Lt_G SArT-N ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRAC OR ADDRESS f well/septic
<br /> 3['g , l<i a,scj g,p--
<br /> (City,State,Zip) 5w5173 (City,Stat Zip) Setbacks
<br /> ( rictGE GRA' /Ei f,J) -
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> (ocog_8'?7, 1 G pplicabletownship.
<br /> E-MAIL ADDRESS E-MAIL AD RESS
<br /> ehri S. tti,%f 1'r, COns1'rve}'1.3nc7 cr. \ Cc3, �V���VVVJJJJ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:/laccessdann Pz aane.wi.us/) �-y
<br /> PARENT PARCEL N MBER: CURRENT ZON.• ,i "°REAGE: L1e7 Elevation of property
<br /> ❑ PARCEL ^ frontage drawn to scale.
<br /> NUMBER 00 8 0-1 /Q - 3C.3 -�5,) 5o - 1 /T� EX ., O. S D
<br /> TOWNSHIP: SECTION: , ��
<br /> ❑ Drivewayimits r 4,�
<br /> lam>.)G, GRcrtlE 3CP ., S /./<: NE (ste•county,town) i x
<br /> ADDRESS:
<br /> Arr 3 , 6 Po-5 OW,J• -(L
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> Di'(9 4
<br /> PROPOSED PROJECT INFORMATION i :
<br /> PROJECT DESCRIPTION: °m
<br /> RC—IUIL-(7 3f,e- — 3L,R,■1C� 13b-1-,) ,J
<br /> . XThis project is a new building or structure. „° ?,
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: :4*Iiiiiiiillitiv*:::ia:air7f� ai e
<br /> ❑SEWER SEPTIC ` "
<br /> HEIGHT IN FEET: ! ;fit// NUMBER OF STORIES: (Not including basement) ` 3
<br /> I // 2, a 5 -j u i
<br /> AREA TO NEAREST SQUARE FOOT: 4€ ',5.-1
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) "
<br /> BASEMENT: 1ST FLOOR: m ��
<br /> 4, TOTAL SQUARE FOOTAGE: ,,,i �I ,, � �.
<br /> �o g '- ;�:
<br /> _.2�ID.E1.66R 3FiB-Ft90R: �= � �t,�
<br /> r -Cco s 6�� GAR.- 5�5 5 , , :- �
<br /> C 4.ESTIMATED CONSTRUCTION COST: � � - I I
<br /> --0 -0. --0 -♦ ♦ -♦ 0Los7, 00
<br /> (Please round to nearest dollar) i
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NIo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Li Yes No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? XYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ErNo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> L. Is a location survey required? (see reverse) :Yes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes )ECNo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
<br /> (Continue on Back) ■ -► -4.
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