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SUPPLEMENT#o:We6 App# .
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> 'PROPERTY`OWNER INFORMATION:_ , , ` ' _ ::-Mji_., ; C STOMER TO PROVIDE
<br /> OWNER NAME r
<br /> 1)4' k c.,� �-Tc%,\ v a Q roc 5S le✓� Zoni Status;CUP;
<br /> OWNER ADDRESS (Number,Stre t,City,State,Zip) n Dee Restriction;CSM
<br /> 2 G 7,/ ,r'r-r F e 1 v` Nl u ;..eC s- k'1 5-.3$7 7 Var. n ce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> &Or— x37_,3 Sr r 6 , a - 5:-3 Y6 ifs/-■h ■a-50,-` r (it rili.'(-.-. ne-� ❑ ite Plan drawn to scale
<br /> �AGENT`INFORMATION CONTRACTORINFORMATION` ' p,t', nd includes dimensions
<br /> ' AGENT NAME CONTRACTOR NAME
<br /> Se 1 F S'c f r ite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> PHONE PHONE ❑ Plan royal from
<br /> plic' a township.
<br /> E-MAILADDRESS E-MAILADDRESS •
<br /> loor plans to scale
<br /> PROPERTY/LO CATION`INFORMATION (httpalaccessdane co dane'w.use 3: , Elevation of
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: . property
<br /> PARCEL //�'� ((�� 1 o Q frontage drawn to e.
<br /> ❑NUMBER VCgU �CJrI$I� ��v ', � 1\� �
<br /> TOWNSHIP: SECT
<br /> t? U o f-,4 S y<: N p %¼: 2 F ❑Driveway rmits
<br /> ADDRESS: F (state unty, - n)
<br /> 6 9 F y AA, 6I ,e_ rc,,,..„1c L.JS 5- 37/-7 ❑Sanita• permits
<br /> CSM: ?© LOT i SUBDIVISION BLOCK/LOT •u• c,private)
<br /> PROPOSED PROJECT INFORMATION _ - ;1,. ;STAFF REVIEW
<br /> PROJECT DESCRIPTION: p l
<br /> I✓a-E-1,-(, e,.,r, / S<-,rc e,, f c r L oning Dlstnct `d
<br /> This project is a new building or structure. D' - "
<br /> Phis project is an addition/alteration to an existing building or structure. - �, -w� z: ' '
<br /> ® RUra dsdrey SANITARY SERVICE: PERMIT NUMBER:
<br /> EWER EPTIC ) - ; n
<br /> ( e extn
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) r
<br /> `❑ Wetland/Flo ain/ -
<br /> • Shorela ;(aitachme _
<br /> AREA TO NEAREST SQUARE FOOT :f_1,;=.,.7.-s _'-%i'.!:''''_
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) r • F =
<br /> 0 ErosionContr• •emit
<br /> BASEMENT: 1ST FLOOR I�� 5- tid
<br /> 4, TOTAL SQUARE FOOTAGE: 4, sSIOpeS �IY rbance
<br /> Jas filling7a ess1
<br /> 2ND FLOOR 3RD FLOOR 1/��f 5 G c 'z y } n
<br /> fl ReviewlisamiOf SUrvey 1, J
<br /> ESTIMATED CONSTRUCTION COST: Q • and va allabfe pt ons �/
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ •V 3ci��' j.;'gf-, __ ,it
<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 ENo ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ❑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) [fres No ❑Don't know
<br /> 7. Is this to correct a violation? Efres al
<br /> li ,
<br /> APPLICATION MUST BE SIGNED
<br /> 545-»2(4/08) t �� (Continue on Back) —► -♦ —►
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