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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER E l\� ) Oren-1_07j ,
<br /> C r 0+ I" L L C ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Numher,Slreet ity,State,ZI )
<br /> te j 3 Deed Restriction;CSM
<br /> 1ILlLth) lt,t u Variance(# )
<br /> •ME• 0 CELL PHONE E-MAIL ODRESS
<br /> i/ j., a 0 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NA
<br /> lME�1 1 1,+ { f , 0e9 ,l.L ❑ Site Plan including location
<br /> AGENT ADDRESS Co T 'CT RADDRESS of well/septic
<br /> 8 A S4_6ofrc
<br /> (City,State,Zip) (City.State,Zip) ❑ Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> applicable township:
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi.usa ❑ Elevation of property
<br /> PARENT PAR EL NUMBER: CURRENT ZONING: ACREAGE: P P rtY
<br /> PARCEL j� jg frontage drawn to scale.
<br /> ❑ NUMBER ©� �� all a���,�11 g
<br /> TOWNSHIP:Ui 41,07 SECTION:
<br /> ,/4: 1�,/: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 1 / .) ) G I
<br /> CSM: LOT i SU:DIVISION try BLOCK/LOT ❑ (public, permits
<br /> (public,private)
<br /> ri a 1.
<br /> PROPOSED PROJECT INFORMATION -7" S4 '
<br /> PROJECT DESCRIPTION: ffilliMilliff - ,, ,., . ,. -
<br /> e ,/,, ikohe- , e._ Illizir,„:1-Tr;-0„. - ---:- . -
<br /> . 4-This project is a new building or structure. ,, j,l$ ,,
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERM MBER: Pi �,if'i P1°(?, bps
<br /> 9 ASEWER CI SEPTIC 1 i34 "ki
<br /> HEIGHT IN FEET. as,-- 1 NUMBER OF STORIES: (Not I - ding basement)
<br /> 4, 5/)('!ji.iie--s 11',?,14 l'3at 4-y -
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ;, � t k ii4,11 . �j�E ,
<br /> BASEMENT ISTFLOO
<br /> . �i 9 sic j, TOTAL SQUARE FOOTAGE: 3 :-.L-I; rs4� r +�z fi x
<br /> 111 �����`""'" f Itl;1,"r 1 7T.
<br /> 2ND FLO �, 3RD FLOOR: = 3 J 3 T
<br /> /IMIUL". I i q f^rF�.a yr q 3 ""''' `,1.
<br /> ESTIMATED CONSTRUCTION COST: _+, .4. .4. --► .4. $ I O A , 1,„ egg 11((y 1
<br /> Please round to nearest dollar 1 Az.,,. Q°s , q c
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes 4No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EI.No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 4Yes In No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI 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) es -a No ❑Don't know
<br /> 7. Is this to correct a violation? Yes .-g'(Vo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -►
<br /> 545-112(4/08)
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