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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION ,, ., .__;., d4. 4.,i,.1,r; ,4_ ri: :::f:;`1: CUSTOMER TO PROVIDE
<br /> OWNER NAME ,�.�/� �j hi`J 2 _c?Z-' " / `✓ 8 ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Str ,et,City,State,Zip)
<br /> Deed Restriction;CSM
<br /> <<S? /% i GL/ #00/ -7; / -2i -01'1 LI t4/2 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6c 2Zt-0'3P 621— '6'-36 ;_ GQA/$68P ' A/4PO, LOA, ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION T ,,; and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> X1'14... i.9tv/Z.y-- ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION .:(http:l/accessdane.co.dane.wLusn< ❑ Elevatif
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property
<br /> P
<br /> ❑ PARCEL /II O(?Sef> frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: 7jyWbi U 4 SECTION:
<br /> 7n/0/9/`e iz 0 ,/: ,/,/: ❑ Driveway permits
<br /> ADDRESS:
<br /> (state,county,town)
<br /> 3 6, Cd�w1 0,-I;,/ ?a.t ,24" "t.� 0.12...
<br /> CSM: LOT SUBDIVISION BUICK/L ❑ Sanitary permits
<br /> 3 c4 Sp,-i.)-ce 41911 (public,private)
<br /> PROPOSED PROJECT INFORMATION; r; TA 7,
<br /> PROJECT DESCRIPTION: //�� �/ /`n `/ L 5I€ r* '
<br /> re Ck C ZV rA ` , 'K `Z.... / (x,, ct c / 4 ) fi ' q�a , a
<br /> ❑This project is a new building or structure. s
<br /> ,This project is an addition/alteration to an existing building or structure. '' ;� t
<br /> SANITARY SERVICE: a Ttl
<br /> c
<br /> PERMIT NUMBER: , �� �,.,�a , ,,,k,
<br /> ❑SEWER SEPTIC t'itkO Mf,rfiA
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> � '
<br /> z ' Cd-e.ck /la1- , �i�7fT�t a,
<br /> -' .60 ii ' ,
<br /> AREA TO NEAREST SQUARE FOOTr
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ��t � ,,
<br /> BASEMENT: - 1ST FLOOR:
<br /> ,01 r,� ®0: M t era
<br /> 4, TOTAL SQUARE FOOTAGE: 1 �-, a 1 �-s';?�
<br /> x :'ail s� �,* a`
<br /> 2ND FLOOR: 3RD FLOOR: n �
<br /> / _ ,AFT-^ .sue-.-:, _ r- a
<br /> ESTIMATED CONSTRUCTION COST: .3
<br /> (Please round to nearest dollar �/
<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? LI Yes o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? `I 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 /> (Continue on Back) —► —► —►
<br /> 545-112(4/08)
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