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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
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<br /> PROPERTY OWNER`.INFORMATION a..-- „__.,: '. 1 w 'o.1 . ' -.k,': !;:`ii. CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> /C y4- T 601-1l 7-/' S
<br /> WZoning Status;CUP; p L-1
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM �/
<br /> /,PL- LN Lod" --ance Z b
<br /> HOME PHON CELL PHONE E-MAIL ADDRESS
<br /> .1,-Y38-55-0 3 , ❑ Site Plan drawn to scale )
<br /> AGENT INFORMATION`_;:: CONTRACTORINFORMATION , ;, ? and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ' Site Plan including location /1fjA
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic r
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks 2.3 )6,- a r
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<br /> PHONE PHONE 01 Site Plan approval from
<br /> applicable township. dl e
<br /> E-MAIL ADDRESS E-MAIL ADDRESS / I
<br /> PROPERTY/LOCATION INFORMATION '.(http://accessdane.co.dane.wi.usn ❑ Elevation of roe '
<br /> PARENT PARCEL NUMBER: CURRENT NING ACREAGE: A 1 property rty
<br /> PARCEL G�(s?/Q _ Z—SfOe ` [� P /7 L frontage drawn to scale.
<br /> NUMBER 7
<br /> TOWNSHIP: A /SECTION: W A /
<br /> IA kA vk -2 N ,A: if W IAIA: _c /d Driveway permits j///tv/ '
<br /> ADDRESS: (state,county,town)
<br /> -a. ∎-.. e- CtS A 0v (--
<br /> PI Sa permits N ,
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ,; bli• private) 1
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: F''',—,1,.--1 , , r.r. , �°
<br /> 0� / s//,e 01T r: � s'
<br /> ❑This project is a new building or structure. �'e� �� ��.�� ��
<br /> 2 I his project is an addition/alteration to an existing building or structure. ' . , , a
<br /> SANITARY SE-VI E: PERMIT NUMBER: my s�-r 1',-4. SEWER ❑SEPTIC a .1 t s '-
<br /> HEIGHT IN FE . NUMBER OF STORIES: (Not including basement) ��'7-- �--,--1-1 .�
<br /> I / ', --,.. -„,„1,-,2-=-7,ii ' , Ste'q,;,-='::'�s d
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<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) k 3'� "i, ,_
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<br /> BASEMENT: 1ST FLOOR: ?_ • • ', . d
<br /> �� 4, TOTAL SQUARE FOOTAGE: 4, w _ • ad ' '�J
<br /> 2ND FLOOR: 3RD FLOOR: // O '
<br /> AI ESTIMATED CONSTRUCTION COST: ♦ _4. ..4 ..► --► -i $ /� n . a* ® •a oE�
<br /> Please round to nearest dollar `/ «T
<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 ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No
<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 LI Don't know
<br /> 7. Is this to correct a violation? ❑Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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