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SUPPLEMENT to Web•App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER`.INFORMATION 47 CUSTOMER TO PROVIDE
<br /> OWNER NAME at
<br /> OWNER ADDRESS (Number,Street,City,Ite,Zip) ❑ Zoning Status;CUP;
<br /> 2,g/A Co.., 7 J2.0-4-.t 4.-L Variance e(t#riction;CSM )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 2-- 7 0 i )4 4 7/0 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION 1 CONTRACTOR::INFORMATION and includes dimensions
<br /> AGENT NAME �— CONTRACTOR NAME
<br /> ,7;;4,✓ 6f 4s F AV - ,6,✓GA/64 w y ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic
<br /> 57/7 74.1 110ra- .� t _ S//9' 7.e'I4k4va h6At
<br /> (City,State,Zip) (City.State,Zip) ❑ Setbacks
<br /> /7 L-ico-t,Q.d.,.i LA s-j So It `- l=o,,e-a--.( (,<., ..S71.1--,19
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 83 e- - ) Fy 8 —7-W applicable township:
<br /> E-MAIL ADDRESS _ E-MAIL ADDRESS
<br /> •�4ye,jr PI.4.,0,-..4.r,�•w - ,> (J,S/f..r 4,1 ct-i,,,rd. co.., C) Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION .(http://accessdane.co.dlane.wi.usn ❑ Elevation of
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property
<br /> ❑ frontage drawn to scale.
<br /> N MBER C711- 193- R(®(o -5 C- i " 1115 " 2-(4,(,7
<br /> TOWNSHIP: SECTION:
<br /> C� i�c 610 JA—/ '/: %IA: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 2y/8 C.uArry /Lo-,-L 7' Aiq dpi (v, 5)?'!
<br /> CSM: LOT SUBDIVISION BLOCK/LOT 1 O Sanitary permits
<br /> 8151 2 (public,private)
<br /> PROPOSED PROJECT INFORMATION .
<br /> PROJECT DESCRIPTION: l
<br /> //id/at O` An)s)/tom �tl44L Si/JS o,(-J �e17. L' ef4 el-um---7;.Jd - - :,
<br /> ❑ his project is a new building or structure.
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANI ARYSERVICE: PERMIT NUMBER: " "
<br /> ❑SEWER ❑SEPTIC
<br /> HEIGHT IN FEET /L' •/,%o;,,, CAA..E✓ NUMBER OF STORIES: (Not Including basement)
<br /> C/i.►S LA-10/�i.M7►7 /2./14•x) ' / ti,
<br /> `'�
<br /> /AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) Y : _
<br /> i T y,
<br /> BASEMENT' 1ST FLOOR:
<br /> 4, TOTAL SQUARE FOOTAGE: 4, r:
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: po I may}
<br /> (Please round to nearest dollar) "0. "♦ ♦ —0. ♦ -► $ I, __
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes . do ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes f'o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? • ; JO ZC )b- 0[05 3
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) eave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes "!o
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) —0. -0. --o.
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