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1.� RECEIVED
<br /> APR 16 2009
<br /> ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web•App#,
<br /> DANE COUNTY PLANNING&DEVELOP ENT
<br /> PROPERTY.OWNER INFORMATION°,.. ._ __ •. W' ',a- s =ri .,-. ;� v`., ,f-:- CUSTOMER TO PROVIDE
<br /> OWNER
<br /> NAME
<br /> S AM S
<br /> D ) S e'2 ❑ Zoning S s;CUP;owN DoRess (Numb*st eec,city State, eed triction;CSM
<br /> M f z5-a CT Y H v ; V v 'calriG
<br /> W\ S 3s-93 ari ce(# )
<br /> ME PHONE CELL PHONE E-MAIL ADD ASS
<br /> 3Z- ite Plan drawn to scale
<br /> AGENT INFORMATION.-i: ' CONTRACTOR JNFORMATION'., nd includes dimensions
<br /> AGENT NAME COKRACTOR N E
<br /> r? Q►Y)S Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADD SS well/septic
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> 1-39 Ci n V,f to LA) ) S314}3
<br /> PHONE PHONE r ❑ Site Pla pproval from
<br /> U 61 3 --1,173 ( () ippli le township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> oor plans to scale
<br /> PROPERTY/LOCATION:INFORMATION:;(http://accessdane.codane.wi.usn ` Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENTZO IN AC GE: p P rty
<br /> ❑ PARCEL D �8 O�TY `) D) c? -0 �„� , 0� frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: s SECTION:Two r )01 1..6 -e._ is 1 i s Nt Y : S ❑ Driveway rmits
<br /> ADDRESS: l , (state ounty,town)
<br /> \) ` W ❑ Sanitary•-rmits •
<br /> CSM: LOT , • B OCK/LOT
<br /> (Z 1-c-5- (pub''•,private)
<br /> PROPOSED PROJECT INFORMATION -
<br /> JECT DES RIP_ON: r ,- ,x ,, 7 ..„-Ti--�
<br /> e ha3T m r
<br /> ❑This project is a new building or structure. A
<br /> 4;-:.4, ¢ 4
<br /> This project is an addition/alteration to an existing building or structure. '- m rc it
<br /> SANITARY SERVICE: PERMIT NUMBER: A vA.. 4 ,,-
<br /> ❑SEWER SEPTIC + 4 :F,^�'91 v
<br /> HEIGHT IN FEET. NUMBER S F STORIES: (Not including basement) kVI „ 3 - r
<br /> AREA TO NEAREST SQUARE FOOT: ---f.,,„„- �,-,,. 1 (\W'
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) s ,-k� � � $
<br /> BASEM NT: 1ST FLOOR: _ a�. O V r. - " I
<br /> I C S .3 CC 4 TOTAL SQUARE FOOTAGE: 4, �'
<br /> 2ND FLOOR: 3RD FLOOD , ,,,,,,,:::-.1 VVV ,,,,,'
<br /> ESTIMATED CONSTRUCTION COST: ,�� t%. 4
<br /> (Please round to nearest dollar) "'o- -i "'∎ "'∎ '∎ '-• $ .g��Z -4,„„, x
<br /> 1"?a64- Inv le '''
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? III es o ❑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? LIYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Cil 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 LI No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes Lt No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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