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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION
<br /> OWNER NAME CUSTOMER TO PROVIDE
<br /> Ctiaa-t-, CharY,ne al, ,t. c11 k -P ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> Deed Restriction; CSM
<br /> //1 0 0 <°3c) %0- 'L-re coun:� f%'ctQyrl Ctl4- 4 L Variance(# )
<br /> HOME PHONE CELL PHONE E-MAILADDRESS
<br /> 8" : . , 74 • r ti --s-/ -HS 5 -v.)v DQ_,cl --0-,ctro-u2/- Co,),-? ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Li t Alit 13-Gs ( CVtLel J i r{.(t S J ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 5 0 S E c t s-- Gel F P r 4 min i t a , c o-s-u_ rrc ;F M i tE_n 17 6
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> t9rlr.ii icy fie fc ht.S ,L- (9o`ti 141111.1)611 /-�-e.t•c r)S IL 4c Oct
<br /> PHONE U PHONE J CI Site Plan approval from
<br /> `//`( Y02-2 /0"7- pj`' 1 96 / O G o S applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> /1tivi 0._Cc,G-Ofi f KJ,re(e5<i cc'o ,,rnSCt t,' ?La joilwri,c Z w'f.e6sS.I vi'''I ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co,dane-wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property
<br /> ❑ P NARUMCEL BER c a0 /0 - /a3 _L 65,_v E'_ frontage drawn to scale.
<br /> TOWNSHIP: ` SECTION: 1/4 1 1 ❑ Driveway permits
<br /> L : <S� /a/4: N i,� (state,county,town)
<br /> ADDRESS: -
<br /> 33 q a- 7¢re- 6 92tu-Q--
<br /> 0 Sanitary permits
<br /> CSM: C{ LOT , SUBDIVISION BLOCK/LOT
<br /> (Uc 8 (public,private)
<br /> PROPOSED PROJECT INFORMATION * AF '':,-0,-,,'°. --'
<br /> PROJECT DESCRIPTION: , ,
<br /> Zoning
<br /> ❑This project is a new building or structure. 7 , ❑ Pe411ter se
<br /> 14This project is an addition/alteration to an existing building or structure. A
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> ❑ Aura Address ii
<br /> 4
<br /> ❑SEWER U SEPTIC r„�tleW� % _�>
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) , }`, r. r
<br /> - .,,wetja ,e,..eg„,.1.1t.",..,„„.
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> PtlYWAZva44.95)4:0,, !kW
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) :,� �`,
<br /> BASEMENT: 1ST FLOOR: �t 1r
<br /> 4, TOTAL SQUARE FOOTAGE: 4, �� ,,
<br /> 2ND FLOOR: 3RD FLOOR: P 0
<br /> *. x
<br /> ESTIMATED CONSTRUCTION COST: ,,J arid' .. . 1 V
<br /> (Please round to nearest dollar) "'∎ "♦ ♦ ♦ ♦ "� $ 3 J ! ()co . �'
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes CliNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? LI Yes I1 No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? 1:4 Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? (4Yes ❑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) ❑Yes U4 No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes All No
<br /> 01 APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ♦ —► -+
<br /> 545112(4/08)
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