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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO•PROVIDE
<br /> OWNER NAME
<br /> G0>-\,trtA,CI %./PIA)-fit-d e ms° i' ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> t o ; P 41.A.v-f_ 7rM 6.1..013?—,.. .)a,4,4rn;GAAA.e.!< (0/7 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> E} "4 7 (.0 5 33 `i/7aa, S S3 :xc)'*- :si tsfhYOmcv/emn rOtr-ow ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 4#v7 C!-''(w CO'? u-i.d tit e,{ v.1 ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> O. •C. �t./Car& 644, 0 e ST J e -c iecl�5.t,c,z, d-7
<br /> 5 &
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> II G(gYtV7 i L_ Q d c-r _it.,! , kvtO /t=
<br /> PHONE PHONE GI Site Plan approval from
<br /> `/i`7/ 4/03 3/613 ey _ 4( / 060/ - applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS
<br /> best a-cov? .orcifq u),,rt M:S.& cG/'1 -pyLsoutort-Q. (opiccpzlicf Ul-�.�,/r .t ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) El Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y
<br /> Li PARCEL 4_/ frontage drawn to scale.
<br /> NUMBER a cS0$ 0.3 &K 0 ci
<br /> TOWNSHIP: /,�,( SECTION:
<br /> 5at.���- '�'
<br /> (state,county,town)
<br /> 3 1/4: c'V 1/41/4: n/& 1:1 Driveway permits
<br /> ADDRESS:
<br /> /., G 7 :6a/tom _
<br /> CI Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION TAT REVIEW $
<br /> PROJECT DESCRIPTION: 4 i ja CYI cfr)f-(l'4 /() Ck St 'vti +)ulie_i— -F A c.kre P?CX Ce 4 } i z zg.
<br /> 1 C, EscfSe Z ni
<br /> Cc-lbrne.t- 2r. ca; �►•t�C.�',-f ��� �,„ ,� .
<br /> El This project is a new building or structure. 0 IPer
<br /> at This project is an addition/alteration to an existing building or structure. .
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural - "
<br /> ❑SEWER ❑SEPTIC (newt ' ® t,, m x
<br /> HEIGHT IN FEE Q NUMBER OF STORIES: (Not including basement)
<br /> r Flo ;
<br /> i '� e
<br /> AREA TO NEAREST SQUARE FOOT: ` �,4,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) V r :.. . 1�,,,„ �;A:. ,
<br /> a
<br /> u � ;
<br /> BASEMENT 1ST FLOOR:
<br /> ,�, TOTAL SQUARE FOOTAGE: ,�, ,i, •s rr' �!0
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: c� a
<br /> (Please round to nearest dollar) ”. "♦ ♦ ♦ -. -♦ $ a ',0 o 0 • � 3 e R
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lallo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes fa No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 11(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) DYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes p'No
<br /> 3.....' APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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