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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
<br /> PROPERTY.OWNER:INFORMATION wz i.- ;:'.114'1,,.M.W `.-?- w CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> CO r y t Z s-
<br /> OWNER ADDRESS (Number,Street,City,State,p) n K `� CI Zoning Status;CUP;
<br /> Cr s� / Deed Restriction;CSM
<br /> Jc ' p 4 .t e c/ J p/if ail "v )f G1': SJid3 Variance(# )
<br /> HOME PHONE CELL PHONE E- AILADD11tESS
<br /> !4),00 10 6 jj 40 57!- t[ 39/ ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION <:;_ '. CONTRACTOR INFORMATION •": and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME /,0-rr/
<br /> W✓e/604r' GAO e 5 /4 w oo 0 ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS ` `/f / of well/septic
<br /> ji c-(.7l f Lc-,n o. - . rti Gam-// d
<br /> (City,State,Zip) (City,State,Z p) l ❑ Setbacks
<br /> rµK„v.nr I.. s-3 s'1.4
<br /> PHONE PHONE 1 ❑ Site Plan approval from
<br /> 6 Gf-p(2)-- 2 3 a/ applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADD•ESS
<br /> Farr 4` 04t00 J oar R!;rea k s+K . ON+ ❑ Floor plans to scale
<br /> PROPERTY/LOCATION'INFORMATION (http:llaccessdanct.co.dane.wiass/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: C RR TZI. I• .CREAGE: P P rty
<br /> LI NUMBER G/d/oo 1, ?o/ /185/oo " 7 �� frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> t r i ,S`-'.r a r. CI 'w 1 1/4: -"G� 1/1/: 1 7 G ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 1
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> 26q
<br /> PROPOSED PROJECT INFORMATION , ;. ' r Fes" 4
<br /> PROJECT DESCRIPTION: I'' x -
<br /> / O/ " d- V 13e-"7"a c.t 14'7' ' ' a r SIC '�- t r'i`1:111 :,iili ,'' 3 7..• ;
<br /> pil This project is a new building or structure. 7, 1 ' '
<br /> ❑This project is an addition/alteration to an existing building or structure. ,` ‘q4- ur
<br /> 6i i
<br /> , a SANITARY SERVICE: PERMIT NUM ER: € , °�
<br /> ❑SEWER in SEPTIC � L702 L _
<br /> HEIGHT IN FEET / NUMBER OF'TORIES: (Not including basement) ..,,_ --'
<br /> / / / ''- ' n , aB„ Pz i-*� ,-
<br /> AREA TO NEAREST SQUARE It 00T: ,„.„; -,,,I,-.,-_,-`,---,. , l,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' - ' #
<br /> BASEMENT 1ST FLOOR' ) s-- a .- —-
<br /> 8' / 4, TOTAL SQUARE FOOTAGE: 4, a e *r 1 i �r s.
<br /> . -. ,� s�—kwr 1 _
<br /> 2ND FLOOR: 3RD FLOOR: I � _ '
<br /> ESTIMATED CONSTRUCTION COST: .4 -0. -+ � $ / .2S dJ "; �.4,,� -1
<br /> Please round to nearest dollar x sx
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property's ❑Yes 't1 No ❑Don't know
<br /> 3. Have you talked with the township about your project aid are they in agreement? R.I.Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property,in the past 5 years? ❑Yes 54 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) 4 ❑Yes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -O
<br /> 545-112(4/08)
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