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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME -
<br /> a YY LE/LCC,9-i.• %!rt"2k---' CO-7 y -C(riA'
<br /> ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> //U/ fv,:i r,- dL-Zt,--z_ 7co) ef-CoG'c._-:.Sc.-61cA., �i.c, fe--cPc(7.—' Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> • \-(-7 as - 5-53 . 8-#7 SS-3 _x d . 5k 1 1 5'C>_cxint vicao c t i' co i Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> /-/-al 40"/C53 -- c/i 717/4 4 ./ (P'r7 t;rta( A G4)t/ ie) U Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> Sc:"7 c iv - ,L.Cu , . 6 t- 55 s 1c .-' c 0
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> c A - c k_ t/oi9Gvto IL- -& ,./e .-, iL
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 1/`f `-/O 3 3/C0 ?j e4T.-7 9•8 / O c"c' / applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> / be-4'M 0_,COncor-d;ci 4,(1,r (e:5;. cOw? .CcylC&-c,ct pj, e/es Cc.+,r/ ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usl)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL CXz/0 (9c-7/ 80a::,' (71 4-/ 4_a frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> Lt( V) ✓1 c:2--eL 1/4: NI E 1/41/a: ,x;Er, ❑ Driveway permits
<br /> (state,county,town)
<br /> ADDRESS:
<br /> 3 7S— Ali i..ft ¢.Q-P'ti
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATIO '4:;::: =4.1.0't � ,L
<br /> PROJECT DESCRIPTION: t4 c- CJ� ci i Flvv b eKi'-�re,t_5 fvit)Cf (." f , shy
<br /> C¢tOrnt4- ,t,YJ%✓1,.,,, ^-' Zoni ias �t
<br /> �` C�. tx�°51 e✓1 Cxt'.`_,lr�q ��c }-Fe�r'�i
<br /> J
<br /> ❑This project is a new building or structure. ❑ Pertrted Us
<br /> 3This project is an addition/alteration to an existing building or structure. ,. A
<br /> SANITARY SERVICE: PERMIT NUMBER: ura A
<br /> ❑ f t, r
<br /> ❑SEWER ❑SEPTIC (new/existing) �Vi 02
<br /> HEIGHT IN FEET: - / Q NUMBER OF STORIES: (Not including basement) t - 0 =
<br /> :4:1*,010:-.r:,1 0.:.A--0 r,,I. :!„..%.,.:.:.,,,,,,:,,'d
<br /> AREA TO NEAREST SQUARE FOOT: � n - * *0�
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) `BASEMENT 1STFLOOR: $ ��4, TOTAL SQUARE FOOTAGE: ,� i -. i'
<br /> 2ND FLOOR: 3RD FLOOR: a : it4 R %;-
<br /> U Rev ew �,�
<br /> ESTIMATED CONSTRUCTION COST: / ' {�OCO(Please round to nearest dollar) "".
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes 1 No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes in No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? W 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) aYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ck No
<br /> / APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -I► -► -►
<br /> 545-112(4/08)
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