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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> 314-7Lf0
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME -
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP;
<br /> Deed Restriction;CSM
<br /> 110 1 P,1't-(:r 2 CLt.A.�4_ 7 of)tiLavt. L..c1-7ou4,,,ti/ R,. 4i Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> v `I -1 - - , -S-S3 cb 4-7 -V.S‘->-5- S(c rt.,51.17-/,541-1.1Q,c!Iw eL-'1 n10 /t i've/'{a-J Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> .-r Sc/ /9-00 6-0/01 107-/n06:le (rir1 CP- C &t) 1.-t-etiel ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> - O Ccuy- i•-y,Rvf .)i,u,U 0 50 3 cram` Zi ...Sw,t.L. O?b
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> j -C.i .C1 J./ u 00/)S ettic;,ortv7t./-;7c/ J.( G'OOO 3
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> '17Y(7033/e 8V 7 c1C / 0eI0 applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> (6..t•-c1 C (cv/ccu/c/q ui,,e(p35-cch? - 11,sr c(ci1_e_c ileryr ixi/t)'iYE 1P -0O3,7;❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dano.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: A REAGE: ❑ Elevation of property
<br /> ❑ PARCEL C)(4 _ /O/_ _ _ frontage drawn to scale.
<br /> NUMBER CU C -,9, -
<br /> TOWNSHIP: SECTION:
<br /> ❑ Driveway permits R-c�'°s`^ 1- :� p /(D Y4: :v e 1/41/: /4 v‘...)
<br /> ADDRESS: (state,county,town)
<br /> d r 6 ,/ A -&. Q- 04-- ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: yci av,. 14„",. 94., ccL �, rry �-
<br /> pA-e.c._t( C1, ex.��31 Ja ` 'r`„,�1 Zotn
<br /> ❑This project is a new building or structure.
<br /> aThis project is an addition/alteration to an existing building or structure. �4 '.,
<br /> SANITARY SERVICE: s a
<br /> PERMIT NUMBER: �I�uCdl�(�t'�s �
<br /> ❑SEWER 0 SEPTIC ne J -g= a
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4 $
<br /> s � 9, ass
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ? .:=
<br /> BASEMENT: 1ST FLOOR: gy ' r et
<br /> x ,�`,ik 411
<br /> j, TOTAL SQUARE FOOTAGE: ���!A°C l- eats 1,4
<br /> 2ND FLOOR: 3RD FLOOR: - 1 -�
<br /> M
<br /> :2,-;14,,.'"--ffli&VILTW4,j76-4
<br /> ESTIMATED CONSTRUCTION COST: .... ♦ ♦ ♦ .4. ♦ , ucc r,J
<br /> (Please round to nearest dollar) ° '.;�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? IYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? a Yes ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# /66S ) leave blank if none)
<br /> 6. Is a location survey required? (see reverse) UYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes 'No
<br /> / APPLICATION MUST BE SIGNED
<br /> 545-112(4108) (Continue on Back) ■ -0. -►
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