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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#,.
<br /> PROPERTY-OWNER INFORMATION',:, ..„ 0.4P ,'e" x .1 P:=
<br /> OWNS AME CUSTOMER TO PROVIDE
<br /> j r,e:, 1--VAT
<br /> OWNER ADDRESS (Numb r,Streit,City,State,Zip) ❑ Zoning Status
<br /> 4£ 1 e^ A l I L W ■ S3 S D ed R lotion;CSM
<br /> J IS DQ..er, in` —Tr, IV`, CYGIr�D— 6 L aflanCe(# )
<br /> HOME PHONE CELL PHONE) E-MAIL ADDRESS .�
<br /> q2-6674 ).5 37 lo 342-0576 Site Plan drawn to scale
<br /> AGENT INFORMATION „ - CONTRACTOR INFORMATION'? ' and includes dimensions
<br /> AGENT NAME 1 CONTRACTOR AME !
<br /> !v`O`'l `lo"` ?°�'` s to.. e /ta- 1.b �c I s ❑'�S•te Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic
<br /> 1
<br /> (City, tate,Zip) (City,State,Zip) Setbacks
<br /> Ple-dd left, L)/ c3C -
<br /> PHONE PHONE ❑ Site Plan appr rom
<br /> c-7Jc-'G7 / a, 5 applicab owed nship:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> -6LAA .( ,12„,pvois!=' - . het ❑ Floor stoscale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.whus/);.
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation roperty
<br /> Est PARCEL NUMBER ° 3 6 0-7 0 43cx12�C 8c1c 4—/ � q r fronts drawn to scale.
<br /> TOWNS IP: I SECTION:
<br /> JA;ol d (L-f v v, 0,7 1/: w V1/: A j 1 ❑ Drivewa ermits
<br /> ADDRESS: (Stat ,county,town)
<br /> 4 S 1s' bee.v;,. 'T„ ,J kitU Lz-t-v, W \ S3 :CA--2— ❑ Sanita :ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> I cka�}z,,,,,- l )(5 (Pub private)
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<br /> PROPOSED PROJECT INFORMATION, -
<br /> PROJECT RE SCRIPTION: �TA :„ -
<br /> �.°te .
<br /> • aThis project is a new building or structure. a . 'z-A,._.---1
<br /> LI This project is an addition/alteration to an existing building or structure. _- '
<br /> SANITARY SERVICE: / PERMIT NUMBER: � '7 < 't
<br /> ❑SEWER EPTIC � � '
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement)
<br /> O '
<br /> 'iti 9 ��, ,.. S
<br /> AREA TO NEAREST SQUARE FOOT: ,per , - - n
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t� ltBa , .
<br /> BASEMENT: - 1ST FLOOR: m ®� ®� �`
<br /> ( 4, TOTAL SQUARE FOOTAGE: 4, 1 ,5*
<br /> �W n }
<br /> 2ND FLOOR: 3RD FLOOR: /� �� „�
<br /> a,: s,l 6€�, _
<br /> ESTIMATED CONSTRUCTION COST: -► ♦ -► ♦ -► ♦ $ ) © OOO ** 1 ° � �® *g*I �”
<br /> Please round to nearest dollar .; 2-4
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 2ErNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0-No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? G3Yes ❑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 a-No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes 3-No
<br /> 9 7 APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) -► -► -∎
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