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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER.INFORMATION _., .1,4s 91.;w,4;1,x. ...i4: , :w. CUSTOMER TO PROVIDE
<br /> OWNER N40,5 ik
<br /> °S'I~ \'-
<br /> — -e.—' frJ Zonin Status;ADDRESS umber,Street,at�sta ,Zip) C 9 ,CUP;
<br /> o% - Deed Restriction;CSM
<br /> `� Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ��Site
<br /> ( C k\L -)..:D.-)3 L1 Plan drawn to scale
<br /> AGENT INFORMATION. ::r - , CONTRACTOR;INFORMATION 2?• and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> f—
<br /> 44.A.11 0.la-/-615\ u- � Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR A�R S J of well/septic
<br /> -'a� /Cis; ( 1
<br /> (City,State,Zip) (City,State,Zip) Er Setbacks
<br /> f�/:::i_1,.J I,// <1 i.6
<br /> PHONE PHONE ❑ Site proval from
<br /> 6 4, LP-1g )-2 -1_? a • able to hip:
<br /> E-MAIL ADDRESS E- AILADDR SS q � ,--,/,
<br /> (AAu( Vo.�-�.�` �8 e_61.0(,cot,` u∎ Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION+.:(http:l/accessdane.co dane.wi.usl) I Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty
<br /> ❑ PARCEL frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION: Driveway permits
<br /> --- 6�w� -�. ��1/4.
<br /> ADDRESS: (state,county,to
<br /> ❑Sant ermits -raL t 'EP
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ( lic, vate)
<br /> PROPOSED PROJECT INFORMATION, ' ` -
<br /> PROJECTDESCRIPTION: . ?1� "°
<br /> T�� a.>. - _ _(.4 0 , Y r 4
<br /> L This project is a new building or structure. 1 s
<br /> ,mss. i >� - ,''
<br /> ❑This project is an addition/alteration to an existing building or structure. -L_ • :
<br /> SANITARY SERVICE: PERMIT NUMBER: a°>F ', r
<br /> ❑SEWER ❑SEPTIC �'iit€W -
<br /> s
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) V ,-�-
<br /> ��� t
<br /> AREA TO NEAREST SQUARE FOOT: ti .,.. µ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) l 'o� `
<br /> BASEMENT: - 1ST FLOOR: 7Za ®,S.:',',.,„-,:;-,2,-,- , Z
<br /> ,P 15 4, TOTAL SQUARE FOOTAGE 4, b ;„ s- rYY� , ,i °
<br /> 2ND FLOOR: 3RD FLOOR: - �,
<br /> ESTIMATED CONSTRUCTION COST: :•9 a g i it-
<br /> (Please round to nearest dollar) $ 1��/j 0d U � 7, �.�. T,r!...;:-,--
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ed'Yes �❑N3' Li Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Y BNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Zles �❑,No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ESNo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑No ❑Don't know
<br /> 7. Is this to correct a violation? Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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