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<br /> ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT to Web•App#
<br /> PROPERTY OWNER.INFORMATION .,__ ' ' ':' t'rM-0 0,,-. ,.�;-;" ' .:' CUSTOMER TO PROVIDE
<br /> OW ER NAME tr."6,44141/4.3 � J Zoning Status;C
<br /> • e
<br /> OW�DDRE S (Number,Street,City,State,Zi g ' UP;
<br /> ( Y. P
<br /> G ] ,/ 1� A, ,-4 -4 lc�/ t&j' 47/ Deed Restriction;(# CSM
<br /> HOME PHONE CELL PHONE/(� E-MAIL DDREESSSI Variance(# 73 70 )
<br /> 2(2 2770 /r 3,5-d-r;—,(/i , J"4 Site Plan drawn to scale / 2 Vi)(4/
<br /> AGENT INFORMATION CONTRACTOR INFORMATION...;''.'t: and includes dimensions
<br /> A ENT NAME CO T CTOR NAM
<br /> 0i S $/p 1 JA-//7,'-)S P'd S•t-_.. _ .•'ng location
<br /> AGENT ADDRE CONTRACTOR ADDRES - -
<br /> S� 0 I� )U� S06I al° iv2/(rte A(City, tale,Zip) Z (city state,Zip) Setbacks /o�V L//0 S/- 6
<br /> PHONE PHONE Site Plan approval from /L
<br /> 6,)Qj n7s 6 7 6,* 57S ' 6"7.4 applicable township: /CT
<br /> E iLADDRESS ' / E-M•IL ADDRESS
<br /> / iC%�o►r9 ,(L� A- / C , 7 • /(')C' 54 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION '.,(http://accessdane.co:dane.wi.usl) �Elevationof roe
<br /> PARENT PARCEL NUMBER: CURRE ZO ING ACREAGE: / property rty
<br /> L NUMBER 0 I 000,6-2.s 1-10_, 1< /4 r` Z , ) frontage drawn to scale.
<br /> TO�W HIP: SECTION:
<br /> I d u.JoU UP- / ,/, %1A: �
<br /> gr•,county, 4
<br /> Dr' °way permits
<br /> ADDRESS:
<br /> 14 Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) S/ 6 #7'
<br /> PROPOSED PROJECT INFORMATION, ' A �j ��.
<br /> PROJECT DES
<br /> PRC
<br /> O 01j 1 IPTI• :
<br /> ' - - -
<br /> This project is a new building or structure. " .. A a �-
<br /> Daly/z
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: �j 1iI e 07t '_�
<br /> ❑SEWER 2PTIC SI 1' 2 J , " ' at }ui i
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ft 1
<br /> r312-P---:-G - -E - x'7`40 +�AREA TO NEAREST SQUARE FOOT: P �F-
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) $ .Y q.,
<br /> BASEMENT: 1ST 1ST FLOOR: - " ' --05.041 L 3
<br /> 9,114 // �t 11 4, TOTAL SQUARE FOOTAGE: 4, ,„ a� ,e �s t „ J
<br /> 2ND FLOOR:. 3RD FLOOR: 61P1 .,
<br /> ESTIMATED CONSTRUCTION COST• ♦ ♦ ♦ -► -► -i $ _�__ -c i �, o 41i A/ a I4 p I,
<br /> Please round to nearest dollar �j ( -� ' , 'i .,L-":',7:7 ``
<br /> C 53,., Do
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 2 o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes e14o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? BYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ago
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#1r/O ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) -afe's ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes -0K:i
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -+ --• -*
<br /> 545-112(4/08) )
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