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17— (c, 7S(i iil P 3 7
<br /> ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App#
<br /> PROPERTY-OWNER.INFORMATION ";; ,t,tiZ;.:, IV_+M'?-: : 1, .'i `}P1-�} 1'r CUSTOMER TO PROVIDE
<br /> OWNER NAME '/ r1 / t'i' Z
<br /> 5,If-f- Fr;•loe^T 1/ ,.50,//y Y`ep-ecif y ❑ Zoning Status;CUP;
<br /> O ADDRESS umber,Street,City,State,Zip)
<br /> 7?/ i d1vV t2(f / q� O „L-G Deed Restriction;CSM
<br /> I f �L Variance(# /S/S )
<br /> HOME PHONE CELL PtiO0 NE E-MAIL ADDRESS _I j
<br /> 53 — •cc c c/'t S-SAS S 01/ 0 j ■ Q
<br /> ' ' 0e., r ..60 04 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION';: and includes dimensions
<br /> AGENT NAME /� CONTRACTOR NAME /
<br /> Al I -kin �1 54(l v hop eki<y ❑ Site Plan including location
<br /> AGENTADDRE CONTRACTOR A DRL'SS / of well/septic
<br /> 73I efiy 1„,vv— "7kl P .4beif Y IAt - •
<br /> (City,State,Zip) r _ (City,State,Zip) ❑ Setbacks
<br /> lere3G vl A.' S3 57 S ( e%) i U'L 3c75
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 6716 P F ( c )ls,3 s--( Sj applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> S(.q(l -- - '4E1 ;IL j)(,•G4,M ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION :,(http a/accessdane.co.darie.wi.usl) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR E: p P rtY
<br /> ❑ PARCEL 05/0 .._ 9 A -V700-0 Q�} a frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> P 1--1;4`
<br /> , N l ,/: iti„J /%:j 7 ❑ Driveway permits
<br /> (state,county,tow
<br /> n)ADDRE SS: •-1. 1 � m i�
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> I • C
<br /> PROPOSED PROJECT INFORMATION, '.
<br /> PROJE DESCRIPTION: �.. z�F �
<br /> K--t-S C's A -NUL- T. A rk.7..f";',:-:: c?-0 ''' 's: r..-;,--,,, , ,_,;._:,
<br /> • 0 This project is a new building or structure. I
<br /> ❑This project is an addition/alteration to an existing building or structure. r. ,z
<br /> r
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> 4 �* k
<br /> * m --. #
<br /> ❑SEWER 74 SEPTIC / z - , a
<br /> HEIGHT IN FEET NUMBE OF STORIES: (Not including basement) ” ;` `. ,
<br /> AREA TO NEAREST SQUARE FOOT: . ,, ; ..
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) z�� -11..1.,,-,--'71--7.1--
<br /> ',, �
<br /> BASEMENT: - 1ST Fl OOR:
<br /> )1, S-6 jl�, f 4, TOTAL SQUARE FOOTAGE: 4W 'i _i( )
<br /> 2ND FLOR: 3RD FLOOR:
<br /> j
<br /> ESTIMATED CONSTRUCTION COST -► -� -+ -► ,' s gam ,
<br /> (Please round to nearest dollar) �u
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Qi(No ❑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'? ❑Yes No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blaQk if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes ONo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes kNo
<br /> APPLICAUSE E
<br /> (Continue on TION BacMk)T B-►SIGN-► -►D
<br /> 545-112(4/08)
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