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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION ,';;-: ._ _-, ' 4 1. 0,;,r,;° , .4_. J2 ',-12* w CUSTOMER TO PROVIDE
<br /> OWNER NA" g C I U L 7
<br /> ROb� ` - i (� / , ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) pp�� Deed Restriction;CSM
<br /> HOMSH9 yD CELL PHONE L\ f O-MAILADDRESS Variance(# )
<br /> SC1n.•-rte. lOg-07/9-685g, ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION.-,::; �; CONTRACTOR INFORMATION:' ', . and includes dimensions
<br /> AGENT NAME CONT CTOR NA
<br /> ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRAC ADDRESS of well/septic
<br /> /s ptic
<br /> (City,State,Zip) (City,State,Zip) _ , Ett..e.,fiu_c. LI Setbacks
<br /> PHONE PHONE LI Site Plan approval from
<br /> 6 0 -a a c 0V a a , applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION.(http:1/accessdane.co.dane.wi.usn ' ''' ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty
<br /> ❑ NUMBER 0 S d-7 0 y/e 0o/0 • p Na, frontage drawn to scale.
<br /> TOWN IP: (� SECTION:
<br /> r✓?ac v,, tit ,S-c '/<: .1/41/4: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 8744c) col 6.. 20o-cQ ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION; '.` . - T -a
<br /> PROJECT DESCRIPTION: u - '` =-
<br /> '-1 aVe_ . °I' ��et i"7o • �.i r� , .
<br /> y,� xa'8i �, Y � #s ;•tgThis project is a new building or structure. LE c. x
<br /> ❑This project is an addition/alteration to an existing building or structure. , =;
<br /> SANITARY SERVICE: no T A e cS ece, PERMIT NUMBER: 'Zir'I` t° - ' -,„"-
<br /> ❑SEWER ❑SEPTIC x t l ..a1 ": 2-”,
<br /> HEI . j �t< NUMBER OF STORIES: (Not including basement)
<br /> lad; / 21, / ; / 't "§-�? t;A,®rsi—
<br /> .e a€=r�a-,s �i
<br /> AREA TO NEAREST SQUARE FOOT: „ _
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT 1ST FLOOR: ®,, � r,�
<br /> 1 /`� �� , 4, TOTAL SQUARE FOOTAGE: 4, ��� � gt ,, `
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> -- /74/40 . r - , -
<br /> ESTIMATED CONSTRUCTION COST _?',qa
<br /> (Please round to nearest dollar) -► '� ����� , ,4,en®���.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes dio ❑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? `f 'S'es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes `t 2o
<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 Flo 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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