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ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT to Web•App#
<br /> PROPERTY OWNER:INFORMATION i :, r..z=,-h .4:9-4-00..;: .>._. < r,: j `° CUSTOMER TO PROVI E
<br /> OWNER NAME
<br /> `k)
<br /> KZoning Status;CUP; I
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM IF
<br /> 3-4��k_ i' A t' P1 Variance(# �� ��
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> - )
<br /> ,,,, :77V° )v 7 )YC) 3S ' Ales` Site Plan drawn to scale
<br /> AGENT INFORMATION , '.; CONTRACTOR INFORMATION-,;' -1--',. -: and in •- ••••-.! •
<br /> AGENT NAME CONT /TOR E = '-���
<br /> 4[r_ 5"0 IQ 5 Site Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) OA Setbacks © © S
<br /> PHONE PHO �L� �
<br /> Site Plan approval from a•. . -. •• ik-
<br /> ,
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> teal Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION ' (http://accessdane.co.dane.wi.us/) _ e i)
<br /> PARENT PARCEL NUMBER: CURRENTZONIN ACREAGE' ` t/'-. a ion of property / ( /
<br /> ❑ NUMBER �3°/o?oe^Joy'. •"'-2- ,— ) �I 6 frontage drawn to scale. ._
<br /> TOWNSHIP: SEC N: ,� N 1-
<br /> ►�(�, 10 � '/,: S F IA- : ,yv 'V 0 Driveway permits�� el,
<br /> ADDRESSS: / State,COUnty�(1'J/I�
<br /> 35&-) AB , I a, d QM 411111P Sanita L
<br /> CSM: LOT S B I ISION BLOCK/LOT
<br /> �,O t 9 Lev Wit 4 MI (public rivet 0/4 26
<br /> PROPOSED PROJECT INFORMATION. ' - 1T ( 'f
<br /> PROJECT DESCRIPTION: F,/ � �F � �
<br /> 03his project is a new building or structure. r 1 � r_ -.4.-*,-,
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<br /> a. This project is an addition/alteration to an existing building or structure. - r r z SANITARY SERVICE: PERMIT NUMBER: :*(1.4-174,01"--1Q-. a e
<br /> ❑SEWER (� SEPTIC
<br /> HEIGHT Ll
<br /> HEIGHT IN FEET / / NUMBER OF STORIES: (Not including basement) 1"- . F '° ,, 1 ef—r
<br /> a-� ` `tae �- s .� F
<br /> AREA TO NEAREST SQUARE FOOT: 4,4,-";:t.,:-a ,S'',
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Ek * :
<br /> BASEMENT: 1ST FLOOR: / �
<br /> j, TOTAL SQUARE FOOTAGE: 4, :� � � !
<br /> ,,,L,r. :(Iii .t e:-.
<br /> 2ND
<br /> FLOOR: � �� � 3RD FLOOR: 4100 411P • , Aii _ '"/` ---I , 1%PlililM'b ' ' ir!'r41-420:-1/1...its-0141i`o,;--;ii,dx,-,4":1A,
<br /> ESTIMATED CONSTRUCTION COST gig , .®9 g
<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 ©N ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes E No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Y s Q o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? s LI No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank/none)
<br /> 6. Is a location survey required? (see reverse) Li Yes 2 No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes di4No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -∎
<br /> 545.112(4/08)
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