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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#.
<br /> PROPERTY OWNER;:INFORMATION° _ 1 d,4t, , _, .,..._.,< !'''''-'j''''22111, CUSTOMER TO PROVIDE
<br /> OWNER NAME ,^
<br /> treiW 0✓ T" SIC- _owr�ERA (r er,srreer, I s te ) �� � `I% Zoning Status;CUP; C Z
<br /> j / � G f r 7 eD
<br /> Cie';' 76 h/ 0 V W/ Deed Restriction;CSM
<br /> HOME PHONE CELL PHONE Variance(# )
<br /> E-MAIL E-MAILADDRESS
<br /> V Site Plan drawn to scale
<br /> AGENT INFORMATION ,.. I CONTRACTOR and includes dimensions/d t '-
<br /> AGENT NAME RACTOR N E
<br /> } Y G h t r ti� J-1A �r'l Site Plan including location i
<br /> AGENT ADDRESS CONTRA TORAD�DRESS of well/septic J idt
<br /> .�l/r / e v e°—G- 1 1J�.
<br /> (City,State,Zip) (City,State,Zip).- /'4 Setbacks /Y,
<br /> rlA L. "P-tt-ri A 4 \kill PHONE ?Js( XO _e, 2,2�, Site Plan approval from
<br /> applicable township:
<br /> E-MAIL ADDRESS E- .IL ADDRESS
<br /> S3� � � ,C 4Sfcroc3 (I Floor plans to scale # A
<br /> PROPERTY/LOCATION INFORMATION ::(htttp•R/a ccessdane.co.d Ane.wi. sn 01 Elevation of property
<br /> AA r �/o_� l_Ct to _ Z S frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTT�ION/r ,/� fI �`' v._Drivewa
<br /> I d V G N6 1/4: ✓`! G %ix,: J Driveway permits ^
<br /> ADDRESS: ` p/� j� (state,county, 'V
<br /> 3 �/ (� V � � I I �C� � � 1�-� -..-- ��grir permits ,
<br /> CSM: LOT SUBDIVISION I / private) ! '' v
<br /> ► G- r �4s S /Q "4-/t
<br /> PROPOSED PROJECT INFORMATION :' .. � A
<br /> PROJECT DESCRIPTION: •' :, , �(
<br /> C! his project is a t Zy : -- 3
<br /> • ❑This project is an addition/alteration to an existing building or structure. � S g ..,
<br /> r
<br /> SANITARY SERV E: dr p,y Al
<br /> , ;
<br /> ,SEWER ❑SEPTIC A ,t ',,COVr - :
<br /> HEIGHT IN FEET NUMBER OF STORIES: (N.t including basement) ' ,;;-.
<br /> l f'd s. 3 FXmet ,, 'ci) ,'yr
<br /> AREA TO NEAREST SQUARE FOOT: ,0-4.'"6"i'l2,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �x_€ -
<br /> BASEMENT: 1ST FLOOR: ®� �9 � r�ti !�'
<br /> 2- Q TOTAL SQUARE FOOTAGE: �w �.� ,,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> r.,;:wiT416',45.0, 41-E;:,-;t6,:4:4)-:..- A
<br /> --ESTIMATED CONSTRUCTION COST -► �(' /)0 'e ,4.,,,,,-,
<br /> Please round to nearest dollar r� G/ , � :,. #
<br /> 1. The property is within 300 feet of a stream .r 1000 -et fro pon or lake? ) Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near t - .roperty? ❑Yes AKNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes v' 'No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes rkNo
<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 Z No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes 1No
<br /> AIAUST BE► D
<br /> (ContPPLi Cnue on TION BaMck) B. 'SIGNE-
<br /> 545-112(4/08)
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