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ZONING. PERMIT APPLICATION www.countyofdane.com '`SUPP LEMENT to Web•App #_
<br /> PROPERTY;`OWNER71NFOltMAT1ON :_,. a.`r zg g_ - y z ' ..t . r=ye . l,:V:` CUSTOMER TO PROVIDE
<br /> OWNAMAME,
<br /> ' r4 1 FU re - n Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,St Zip) Deed Restriction; CSM
<br /> ---R) --- 06: 305 - er- ,f l c0, (.,,)‘ c-5553 / Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ice 7/a % q Cal 11 ,-( t e 44-G Pmt'ef"- -_- n Site Plan drawn to scale
<br /> AGENTJINFORMATIO F�"" �' ".-r �: ��� Q...� ' .
<br /> JN=„, ,- �- ,�-�r y,����CONTI�ACTORwINFORMgT10Nx,�_�eg.:W and includes dimensions _
<br /> AGENT NAME CONTRACTOR NAME
<br /> ('r ,,.1 ( c .seA-L, n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS • of well/septic
<br /> 3os
<br /> (City,State,Zip) (City,State,Zip) n Setbacks
<br /> erg',-cc 0. Wt 5-3 S3 1
<br /> PHONE PHONE ❑Site Plan approval from
<br /> Co e& 7/D- SG S4 - applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS -
<br /> ❑ Floor plans to scale
<br /> `-PROPERTYILOCATION INFORMAT ION*`;(http.%/a 45'5'-lane.co,vane:vui.usl)t --:i=: ❑Elevation of property
<br /> PARENT PARCEL UMBER: . CURRENTZONING: ACREAGE:
<br /> ❑PARCEL �/ � � 3,997 frontage drawn to scale.
<br /> NUMBER 6 (P OcoIZ-ZZI- O-0
<br /> TOWNSHIP: SECTION:
<br /> ()141€l s7/,+A,u�A— c 2 Ye. 3E ihy... N& ❑ Driveway permits
<br /> ADDRESS: (state, county, town)
<br /> C iQar u,-e , C; -v v tx, -, -5:`. .5.9-.? n Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 1 •.5.-l�. I (public, private)
<br /> PROPOSED PROJECT-INFORMATION '; ''!I'll: P'ti r
<br /> PROJECT DESCRIPTION: am. � _-- -
<br /> , , "
<br /> 0e(_,�
<br /> - ME, ecNS-70-oc_?I pr--I E I4J, @ DJ ISC}`� y -'
<br /> ;7 , ±r _•374}
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<br /> 0This project is a new building or structure. . ii '4 �-,
<br /> P J 9 E I d s '> C,q-
<br /> n This project is an addition/alteration to an existing building or structure. w at °, :;
<br /> SANITARY SERVICE: PERMIT NUMBER: - o° _�..� ,,;
<br /> . EWER F/EPTIC 56..-ed. '- 6-� ^ � f
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) �'` - -�
<br /> AREA TO NEAREST SQUARE FOOT � 4 )IP H ae-.
<br /> (Outside dimensions including unfinished area, attached garages d above grade decks or porches) f— '
<br /> � ,A Q P k...,._,a � s �� �'t�.e�
<br /> BASEMENT; • 1ST FLOOR: Z t _ R ''3`
<br /> .r r ' ' 1 TOTAL SQUARE FOOTAGE: 4, B°� ; ;_ _ °
<br /> 2ND FLOOR: 3RD FLOOR: 3
<br /> ESTIMATED CONSTRUCTION COST: -
<br /> - ' — -t p Q,
<br /> (Please round to nearest dollar) —∎ i--0. I. ♦ —∎ "4. $ • /SSDO0 x _ y ---f---a--=-- 4
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes-' ONo.- ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? ,Yes fNo .❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Oes ❑No. . . _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENO ,
<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 ONo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ❑No _
<br /> • � APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —' —► -9
<br /> 545-112 j4/OB) -
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