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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> i ere(n 0-rii-c(8y►! TSCJ)e A -n.#q0M ei ❑Zoning Status; CUP;
<br /> OWNE ADDRESS (Num er,Street,City,State ip) 535 gi Deed Restriction;CSM
<br /> 2/(17 Co licteltLy aft 4- Dr, /-ouq/lLe" tiJ1. 3 variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 60$-22.5- LILILI mac. ;trun C h)f kee, (-6►•n ❑Site Plan drawn to scale
<br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME ���
<br /> Tp[, Cry MI5C- C1-a /Cram, 4,1, rte, ❑Site Plan including location
<br /> AGENT ADDRESS V CONTRACTOR A RESS of well/se tic
<br /> 03263 C4-, 41, CD iv3Z 63 Cky Re Ld Z-.5
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> coil )2Ivc (,J1, 53932 fall K%uc', WI. 5Y%3Z ,
<br /> :
<br /> PHONE PHONE ['Site P , i:., • :I from
<br /> (bg- 22 o- 69 (ig CoB- 22o - GgyI appli•:, - • ship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Chi wirr tc.41-6--A lot @,RNI^gi 1 • Cra , a,5t ro c1.4),, in : • ,,' ❑Floor plans to scale Ns�D
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property �(F�
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ./
<br /> ❑PARCEL �+ frontage drawn to scale.
<br /> NUMBER O Z 1<,-jo 6o 1-23y-- yab--5
<br /> TOWNSHIP: ,--- SECTION: 'F ,
<br /> OM bit\ �/4. 1/44.
<br /> ADDRESS:Ai r�q '
<br /> '0� ,llad/a PZII&1- Or, )l* LIT i , �1 BLOCK/LOT ❑Sanitary permits '' t
<br /> CSM: LOT SUBDIVISION O
<br /> (public,private) .- --4401
<br /> 0 Co llat?a 'S Di*Alf- (eo _ ` . ;44442'
<br /> PROPOSED PROJECT INFORMATION AFF REVIEWr
<br /> PROJECT DESCRIPTION: ,�/Cl
<br /> NfeJ S1yrik ram;1 i A rang ❑ Zoning Dist �� l
<br /> . IThis project is a new building or structure. ❑ PermittclfiVse?
<br /> This project is an addition/alteration to an existing building or structure. VV
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address
<br /> REWER PEPTIC existing)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> ❑ Wetland/Flood,la rA
<br /> '` Shoreland (a, : : t)
<br /> AREA TO NEAREST SQUARE FOOT: /�J
<br /> (Outside dimensions in?uding unfinished area,attached garages and above grade decks or porches) . /`/
<br /> BASEMENT �/ 1ST FLOOR: ❑ ErosionControl per utiip 1 1 \ ,, TOTAL SQUARE FOOTAGE: + (slopes,disturbance
<br /> i , 136 k, A� filling/access)
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> (1 Ell 15 `lO'l r-2-q5 \ Revi: ,L,
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -, $ Uvt ppp, % and a •(Please round to nearest dollar) I
<br /> Fra4
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [ Yes Llo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes y�lo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes to
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Jo
<br /> c Ic thic nrniart accnriatarl with a ra7nna/C.I 1P/varianra(natitinn/annaal if 1 (Iaava hlank if nnnal
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