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<br /> „SUPPLEMENT to Web•App#
<br /> ZONING PERMIT APPLICATION wwlw.countyofdane.com
<br /> PROPERTY OWNER.:INFORMATION, ,; , ,_ ,4,: _,?,�;V,„; y ,..�._--, t.i = '- CUSTOMER TO PROVIDE
<br /> OW y NAME ^
<br /> //(/l,etiE GeGjLc t -/6-`1 ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> C‘&5'. /h/l' -t/ /?9 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> F3i- SSSc't 1 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION.-:::; - CONTRACTOR INFORMATION :-,":'.',I, , ;`, ,H;;'• and includes dimensions
<br /> AGENT NAME CONT gT•R NA D'. LAY 51 l`+S, I�;3.
<br /> ����gg�RR�� ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACT.RABM2st1°uSta,ig\tt�lr of well/septic
<br /> Madison.WI 53718
<br /> (city,State,Zip) (City,State,zip) ❑ Setbacks
<br /> PHONE PHONE I • ❑ Site Plan approval from
<br /> 022,?_ 5 52 applicable township:
<br /> E-MAIL ADDRESS E-MAILADDR SS
<br /> Tex' . _ a.r X. . CO•--1 ❑ Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION+;(httpa/accessdane.co.danewLusn ` ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT Z• ING: ACREAGE: p P y
<br /> ❑ PARCEL �►,L. i 735 j L9/�. frontage drawn to scale.
<br /> NUMBER �y/6�I1�-�1-.T'!Sr/Z�O-� o lI/
<br /> TOWNSHIP: SECTION: ❑ Driveway Z 1/4: 1/41/4: y permits
<br /> /�G' vF ,�_c.C/P - (state,county,town)
<br /> ADDRESS: •
<br /> ‘,.6.(f;-r 7?7/ 0,),iS6Aet/ /?4 LI Sanitary permits
<br /> CSM: LOT SUBDIVISION 1 BLOCK/LOT
<br /> D -__'_c1 I I (public,private)
<br /> PROPOSED PROJECT INFORMATION. " °
<br /> PROJECT DESCRIPTION: r a S--' "� '-
<br /> ❑This project is a new building or structure. fR• 7g4-„0 ,
<br /> ,This project is an addition/alteration to an existing building or structure. ,T ¢
<br /> r�r},_-
<br /> SANITARY SERVICE: PERMIT NUMBER: 'i ? '-mil°. �”- ,
<br /> C3 ❑SEPTIC � i:1:-.1:��� �i o�k; �, _,:
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) .._
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garage and above grade decks or porches) � c '
<br /> BASEMENT 1ST FLOOR: e• �°'q S
<br /> �, TOTAL SQUARE FOOTAGE: 4, ' Q ��. ° „-- ,
<br /> ;�y� a
<br /> a x
<br /> 2ND FLOOR: 3RD FLOOR: _ �xc r ��
<br /> ESTIMATED CONSTRUCTION COST: i✓-m ,re
<br /> (Please round to nearest dollar) --0. ♦ -► ♦ OC:0
<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? ❑Yes ❑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 ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —0
<br /> 545-112(4/08)
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