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06/16/2009 11:03 608-267-1540 DANE CO PLANNING
<br /> PAGE 06/07
<br /> i n.
<br /> ZONING PERMIT APPLICATION www,countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION
<br /> CUSTOMER TO P O D
<br /> OWNER NAME II II `t
<br /> OWNER ADDRESS (Number,Street,Cn)4 Smta; ,) ❑ Zoning Status;CUP;
<br /> /45to Grethw Rd /na.r/io i ws 53551 Deed Restriction; -
<br /> HOME PHONE ' ceu.PHON E•MAILADDRESS Variance(# )
<br /> Clegg- 4. 3447
<br /> -07 dh - h-u.cficm ' _, fraziar, c, C] Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTFIACTOR NAME
<br /> -0 i 14 co1ns ...cMc,- ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> — (cta5 Wu( L&4
<br /> (can.as*EP) (CIt,stste,Zip) _ ❑ Setbacks
<br /> &rs Pre,.i e . w?• 535o
<br /> PHONE PHONE 0 Site Plan approval from
<br /> 401r-v.25-1010 lava• ift,i-3 '(03 applicable township.
<br /> E-MAILADDRESS E.MAII.ADDRESS
<br /> dhcor, `• •11 44, • • •_ ❑ Floor plans to scale
<br /> PROPERTY LOCATION INFORMATION (httparaccensdane.co•dane.w:.us')
<br /> PARENT 'A- r"'=i-: 11'=T EN • •N4: AGA .G • ❑ Elevation of property
<br /> 0 �RC�. 0//)/0/1,1-0/3'8315-‘f R.7114 1.5 frontage drawn to scale.
<br /> TowNSH1P: SECTION:
<br /> , , ❑ Driveway permits of, yu►A _123_� '4: & 1414: N E
<br /> ADDRE'49: (state,County,town)
<br /> /454 G rce►,
<br /> cam: r� x 53555 BLOC OT ❑ Sanitary permits
<br /> 1880 / (public,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> ' �N;;N 4 y,, , r,
<br /> . ,PROJBCr DESCRIPTION: r 1
<br /> .j M;i:.w• N'S:• .r.,,�.f! nl:i:J i:,n.ud•
<br /> 121This project Is a new N< . ::°r �,, ,',:..w,�a� .�«,,.,w ,.
<br /> prof ew building or structure. :.',w, ..� 1,141 Z . g
<br /> Cil This ,i , ��,I�r�C�::,;,:•
<br /> project is an addidon/alteration to an existing building or structure. °''i''' `', ` '"�''' �'',.
<br /> r"� �rw�,.`��ti5°°;;i�l�:,,°;'M;i:"'if' y kT�'iS :b;'.,1�,,'•'
<br /> rSANr R "•�•'�� u: ••.' Y w ,Y1Kb ii. '^,9.',Y-,: .M'•�11'�_� \�'�}�
<br /> 0 E: PERMIT NUMBER: 4�!. -_!,, ;, I"'a INr•0
<br /> SEWER , }t, + h;;•,• ?'u 'I,`Y„i'
<br /> HEIGHT IN SET: NUMBER OF •: 'Mw.;,, e h.f.0! 'k 1. EXIIIIIM STORIES: (No1 Including basement) 'r 'tS�."•."t,. M ,, ,• t ; ,
<br /> •
<br /> AREA TO NEAREST SQUARE FOOT: -' ' '
<br /> (Outside dimensions Including unfinished area attached garages and above grade decks or porches) r.:',..:., � "'
<br /> Gera-14- 1ST N c. �. .Ev. x. ?a,f .-1.:4,'' r4. ','
<br /> O(� ,, TOTAL,SQUARE FOOTAGE: ,l 4. '� !"'",� '.* 1,1.
<br /> 2ND FLOOR: �sRD FLOOR: +f i r ' n, .
<br /> I I(1 �: ,z4',,.7{� � r !
<br /> . 4y . J -.1.,,Ci r Y
<br /> :e ., s ! ;Y'w ESTIMATED CONSTRUCTION COST: YN r :i o , :,.
<br /> l-lb '► ♦ ♦ �(PI6aSe round to nearest dollar) �. 2� r+ d
<br /> .
<br /> 1. The property Is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo CI Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No GI Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? E1 Yes 0 No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Cl Yes lia No
<br /> 5. Is this project associated with a rezone/CUP/varianee(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes CI No at Don't know
<br /> 7. Is this to correct a violation? ❑Yes Ei3 No
<br /> APPUCATION MUST SE SIGNED
<br /> 545•112(uoel (Continuo on Back) ..4 -•e. .#
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