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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER.INFORMATION ,: z ?, 1;a .4;, ."-i ..t,; i-1 `_ CUSTOMER TO PROVIDE
<br /> OWNER J�M ,, -.. - ,
<br /> // �€ rF/t1 \ci 1_ -� / 05 b�°/(/ rg Zoning Status;
<br /> OWNER AD SS (Number,Street, ity,State,Z'•) g Status CUP;
<br /> 5 6 I1/i US 'J s' , 5 Deed Restriction;CSM
<br /> HOME PHONE CELL PHONE -nCe(# )
<br /> E-MAIL ADDRESS '
<br /> - Ig r ' 4 ' yr' "0 ❑ Sit-''Ian drawn to scale
<br /> AGENT INFORMATION. , - , CONTRACTOR;INF.ORMATION _,,:<f d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 7 ❑ Sitepkan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS `---- ---•.f-well/septic
<br /> (City,State,Zip) (City,State,Zip)
<br /> 4 Setbacks
<br /> PHONE PHONE Site Site.Plan approval from
<br /> applicable township:�.q
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> 4 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION '::(http://accessdane.co.dane.wi.us/)
<br /> PARENT CURREN ONING: ACREAGE: a Elevation of property
<br /> ❑ PARCEL
<br /> NUMBER INNI ,yam �— frontage drawn to scale.
<br /> TOWNSHIP: SECTI N:
<br /> Skill F1' e '/<: s u> % : Aia) a Driveway permits
<br /> ADDRESS: (State,cou •
<br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits �/ �/
<br /> (public,private) airt ,
<br /> PROPOSED PROJECT INFORMATION, -` � s ,
<br /> PROJECT DESCRIPTION: P�� �3
<br /> Nebu SW,yet 5 c-- git-e-C---/ ,.,7::41,--;, :,,,,,,,,t4,--..-,5,.,ii 5, -. ,,.: '.:7,..17 2, if 7
<br /> ,,,.....,,li,,, ,mim.,,,, ,,,,,-,,,...,- ,,.- ca
<br /> ❑This project is a new building or structure. !� � �-
<br /> ❑This project is an addition/alteration to an existing building or structure. r---':....7,:-...,„,,,.. .‘: z _ ___ ,, 0
<br /> SANITARY SERVICE: PERMIT NUMBER: jw-1,-,_,:=nc-_-,,,v4.6rp,s.-- -:—..---r -
<br /> ❑SEWER ❑SEPTIC . �
<br /> HEIGHT IN FEET K ,' '
<br /> NUMBER OF STORIES: (Not including basement) C1.2,:4-,1;-..1" 3
<br /> ��„rQ,�,� �s €^a °tea 7:7's�.
<br /> AREA TO NEAREST SQUARE FOOT: �`' r�
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ri
<br /> BASEMENT: - 1ST FLOOR: -- ° °a q ! , ��
<br /> 7 ,j, TOTAL SQUARE FOOTAGE: , _ g ill;'"4
<br /> 2ND FLOOR: J / i n s � .
<br /> 3RD FLOOR:
<br /> / F F.ttP k-' f
<br /> ESTIMATED CONSTRUCTION COST /I �'
<br /> (Please round to nearest dollar) '∎ —► —► —► —► $ lv UD 0 ' -° `°°'°
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? iSfYes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ®Yes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? R'Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ktNo
<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) RtYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) —► —0.. -0.
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