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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OVER NAME
<br /> l ur& 9e s' i-k Nome.s ❑Zoning Stat ;C
<br /> OWNERADDRESS (Number, eet,City,State,2 ) Deed Restri io ;CSM
<br /> HOME PHONE Hwy CELL/PHONE nt-libur
<br /> p ,�AIL WI 5-31-11 Variance(# )
<br /> (4 06-tf 3:-217(o (o o$-- 3lr)-25040 an®a,(ieA holfrt S,Co eh 124tite Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGWT NAME " �� CONTRACTOR NAME
<br /> tS UVe� A4 -n— kart_ Horr.w Lt.c ite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS' of well/septic
<br /> z't 1 1V ti^A( m m 21--21.7 /rlff)
<br /> (City, t9,Zip) (City,State, ) ❑Setba s
<br /> 0 bvy WI r ,
<br /> M 5-3 /
<br /> PHONE PHONE ❑Site Platys@ p al-from
<br /> 60$- 439-2q% eog-Li 3e-2q 7--k, applica e� n hip.
<br /> E-MAIL ADDRESS I(_�,_ E-MAILADDRESS
<br /> 0-Kt. ' Q., ,en'A liana S.Co/yt an ®GjkYYr,hor'ry S, a r) ❑Floor plans'cale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEIALMSER: CURRENT ONI G: ACREAG)=: ❑Elevation roperty
<br /> ❑PARCEL O .524 7 O 7 frontage drawn to scale.
<br /> NUMBER / L" �� jj'' `�✓
<br /> TOWNSHIP: SECTION:
<br /> /'vt44U1.1k)n 1/4: 1/41/4: ❑Drivew y
<br /> ADDRESS: .�/go , r. ( (state, ,town)
<br /> ( `�+ -r, �. ❑Sanity pe its
<br /> CSM: LOT 8 SUBDIVISION BLOCK/LOT
<br /> /fL2�4 I2- . Es�{a eS (public, ate) v- I ' " 1
<br /> PROPOSED PROJECT INFORMATION , -w
<br /> PROJECT DESCRIPTION:
<br /> rS 1n)jc(1- -Pain s()I 4 Bedroom AGo 6n s/wciio n ❑ zoning ,,,:. , .
<br /> . ['This project is a new building or structure. P IITU, _?
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> EWER MEPTIC 1 3 - 2 04 — 0 03 2 ..," =�e.;rs ,)
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement)
<br /> Alia 2...,I 2 0 Z 1 : 47,. ,., . :,Ity
<br /> i b 11:W t)..
<br /> AREA TO NEAREST SQUARE FOOT
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches)
<br /> BASEMENT / 1ST FLOOR: ,'
<br /> �� V 3U/ ,, TOTAL SQUARE FOOTAGE: ,r - '� =, 'r=,
<br /> 2ND FLOOR: 3RD FLOOR: fit )
<br /> i t 22-7- V ripiq �� �z� D s,.. - Survey
<br /> ESTIMATED CONSTRUCTION COST Q an : ,,. ,
<br /> (Please round to nearest dollar) ♦ ♦ -.► ♦ ♦ —• $ 50O,flop
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes 0'10 ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes a/ o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? lites II o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ENo
<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) Dyes to ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ,lo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —►
<br /> 545-112(4/08)
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