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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY.OWNER;:INFORMATION z, , Yz; ;3M11 a 40-#.,M ,.=, L, :_1 _w? CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> •
<br /> . "' T C s-b)(2-4Y
<br /> cD, WL,i0a l:,;k , L,L ❑ Zoning Status;CUP;O NER AD DRESS
<br /> (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 11(p05 e V , —GG� D24—/l, �'O' I �,, � ST337s -Z variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> (,o —87 I-•0524 0908-333-1/611 ,J: 0`-')57?>211-67c • C1 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION• and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> J r"", (Ai 1(S ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> L1 4r-5 l�verci ree ,. e-e,ur-c
<br /> (City,State,zip) (City,State,Zip) ❑ Setbacks
<br /> j
<br /> PHONE PHONE • ❑ Site Plan approval from
<br /> C0Ji5- -,..?_33_V1C-z/ applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Js,,^ 0�—s 13 .e . CG' ❑ Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION-+.(http://accessdane.co.dane.-wi.us/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P rtY
<br /> ® PARCEL 0 0 S..09'Z-0--)5.0 . C_ � frontage drawn to scale. '
<br /> NUMBER Z -z �� �LrGS
<br /> TOWNSHIP: SECTION: ❑ Driveway 5 Pn�4,(� o9 '/<: &V.,-J '/%: A3 y permits
<br /> ADDRESS: (state,county,town)
<br /> —2 23--`7 1')1 i.tc (r .
<br /> CSM: LOT SUBDIVISION ef.. I BLOCK/LOT ❑ Sanitary permits
<br /> /(-2 r•�rs c :It
<br /> (public,private)
<br /> PROJECT OPOSSED PROJECT INFORMATION ,, . CAF
<br /> (y);A..., — (ti/.4.rC,hv,.� o t_/-/,..,'t-''s j fl s,g I $,_�ri§'C r,..0 This project is a new building or structure. s�3
<br /> ❑This project is an addition/alteration to an existing building or structure. - ' ,- ' a
<br /> SANITARY SERVICE: /�.�0�e_ PERMIT NUMBER:.', ,F� ,'
<br /> ❑SEWER ❑SEPTIC P a-agtaT ? ''.
<br /> HEIGHT IN FEET: V NUMBER OF STORIES: (Not including basement) �,_ ; - 4,--
<br /> 13' IDS' I ,+t�`�t®Ietl _
<br /> N ® qV s s� �
<br /> AREA TO NEAREST SQUARE FOOT: '-, � ,�
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ;
<br /> BASEMENT: - 1ST FLOOR: ,2_ e ® ® ® s z F
<br /> 4
<br /> I Z l U ,�, TOTAL SQUARE FOOTAGE: j, T., si '" fin° ��F�
<br /> 2ND FLOOR: 3RD FLOOR: n
<br /> 1 tt c . A ar't ?
<br /> ESTIMATED CONSTRUCTION COST: w � ' _ '
<br /> Please round to nearest dollar �v0U. �.,,,
<br /> W
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes l24 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 ❑No Zee,-o tk.2
<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 ®No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes tia No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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