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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT:to Web-App#
<br /> PROPERTY OWNER.INFORMATION, ;; _, ' '1,' - a ., >: Cu!,-?:-i = •TOMER TO PROVIDE
<br /> OWNER NAME
<br /> C fta i 41: /PL.r4f1 L 4.J 7 k Zoning Status;CUP;
<br /> OWNER ADDRESS Number,Street,City,State,Zip) _
<br /> g ed Restriction;CSM
<br /> �
<br /> �y /3/, /-4-tz,4•v,0 J/ S .2.S-se ariance(# )
<br /> H E PHONE CELL PHONE E-MAIL ADDRESS
<br /> < J7 �9 ^ ,.
<br /> Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR;;INFORMATION = ' H:-1',- and includes di••- ons
<br /> AGENT NAME CONTRACTOR NAME
<br /> Jim E''►&i/ _ ❑ Sit- - an including location
<br /> AGENT ADDRESS CONTRACTQR ADDRES ., well/septic
<br /> 2 A u Z Mc,cs r4--tit.- ,� y
<br /> (City,State,Zip) (City,State, A Setbacks
<br /> w).4/,cost.) , ( ,Jf Sr-,?)I
<br /> PHONE PHONE ❑ Site Pla approval from
<br /> ;L 2 L ^ 51 CY appl ble tow ship:
<br /> E-MAIL ADDRESS ,, ADDRESS
<br /> , Q ol; ' fJdS -- G, •1'l ❑ loor ns to scale
<br /> PROPERTY/LOCATION INFORMATION '::(http:l/accessdane.co.dane.wi.usl) Elevation of property
<br /> PARENT PARCEL NUMBER: /�, cURRE ZONING: ACREAGE: P P rty
<br /> ❑ PARCEL Q. / 0 _ 1 (p 1 _yy' 1T 2 � r- ') a frontage draw scale.
<br /> NUMBER V' (1p°�lJ •.J �
<br /> TO"wsH SEgTIj�N:
<br /> cl r: )Pki'� c'(\v'∎l ! \p '/<: N Ii WA: �� ❑ Drive ypermits
<br /> ADDRESS: �•, �A 1\ p ( e,county,town)
<br /> (Sd CO O 61\ 1` ❑ Sanita .-rmits
<br /> CSM: LOT SUB ION BLOCK/LOT (pu• c,private)
<br /> QG © b o2
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: i T °� �"
<br /> ❑This project is a new building or structure. : , i �
<br /> ❑This project is an addition/alteration to an existing building or structure. '- ,. ---'r-,,,,,71',---T ''
<br /> SANITARY SERVICE: PERMIT NUMBER: W aa v;1,- , ;
<br /> 4� � i❑SEWE- I: - C •HEIG ET / V / NUMBER OF STORIES: (Not including basement) - £ s Y
<br /> � ` � ����®ice `°�' ' ,
<br /> AREA TO NEAREST SQUARE FOOT: ; r
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . ;,-„,,-,,k4,--`,71, x
<br /> BASEMENT: 1ST FLOOR: ' ,;«,' s BQ �g5. per .
<br /> 4, TOTAL SQUARE FOOTAGE: + ::„.3 -k,"4,19 ,,,:-,t!...! L�"
<br /> 2ND FLOOR: 3RD FLOOR: a `-°-Y*' f+
<br /> ,mom - - c
<br /> t a C d �tEi F { .
<br /> ESTIMATED CONSTRUCTION COST: r'� m ,11
<br /> (Please round to nearest dollar) ♦ ♦ ♦ "� .il , �TLy
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none)
<br /> 6. Is a location survey required? (see reverse) CI Yes o ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(408)
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