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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
<br /> $4.iOG r 44 A/g •
<br /> PROPERTY OWNER INFORMATION i , . ti=;; 1 _1 .;414-V,:r �.=,- c; :_ :,:, CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> D RFE 2 (3� sk G
<br /> �E OT�f"�RS � CI Status;CUP; TA
<br /> OWNER ADDRESS -(N,umber,Street,CCi�itty,State,Zip) a Deed Restriction;CSM
<br /> HOME PHONE w A CELL PHONE RD / V C oLADD, L). c3 5-9 3 Variance(# )
<br /> 60S-sys-0674' 6o8-Yv '-o te96 j ydOCrfer Q tdS,ne.'t{' ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION ;,:, , CONTRACTOR INFORMATION • and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> JC N,J DoEKFE(- ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 54 yn E A- S ,qB
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 6(g- ii-.5--65-6 74 applicable township:
<br /> E-MPJLADDRESS / E-MAIL ADDRESS
<br /> ♦ d,oer ,. r± ❑ Floor plans to scale
<br /> PIMPERTY/LOCATION:INFORMATION+.:(http:l/accessdane.co.dane.wi.usn " ❑ Elevation o
<br /> Elevatiof property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y
<br /> ❑ PARCEL /�/ G / �f / frontage drawn to scale.
<br /> NUMBER VlDOO ���Y'��Lbl-� � "t / � � /�
<br /> TOWNSHIP: SECTIO �.f -god RrE
<br /> v eg o nbq ^/E 1 .S6 ,/%: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION. `"
<br /> PROJECT DESCRIPTION: ,
<br /> This project is a new building or structure. 4A N 1 5 2009 i, , t 114 , -
<br /> ❑This project is an addition/alteration to an existing building or structure. : 4
<br /> SANITARY SERVICE: ,, tf r`
<br /> ��
<br /> 0 SEWER SEPTIC NE-COUNTY PLANNING&D EVE1Opp x m � 1 k
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) > r `, r
<br /> AREA TO NEAREST SQUARE FOOT: =-,0„.4 x
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,, xi � :
<br /> BASEMENT: 1ST FLOOR: - a "tV, r
<br /> i 2 0 0 o ,, TOTAL SQUARE FOOTAGE: 4, , d �
<br /> 2ND FLOOR: 3RD FLOOR: �� '
<br /> n ' 4 -. e;
<br /> .` ' P
<br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ -to d � tr73
<br /> (Please round to nearest dollar) �2 b O .Y.,:.-".° r
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes TO-No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes , Jo ❑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 ONo
<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 IgNo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes f,No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -4.
<br /> 545-112(4/08)
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