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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> /`1 -Y-------; ') /ii f. Z ._ ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Z' ) S 3��j Deed Restriction; CSM
<br /> ef�9/?3 "—e ' - e Z`'--16—e,_;) Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -e -r, 6P,�yp u�-L
<br /> v�— 7/ Z -Z Z Z robfec-7'`,-o rr,.,P s /im u v S et, ,❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION ' and includes dimensions
<br /> AGENT NAM / � CONTRACTOR NAME
<br /> / 'l/y/ .CA--V- „ 7. " :::- ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS j of well/septic
<br /> 2 7 ,ev .0r,v7 fly —9/?3 ,04,:e7 j-e�e,e�=.-
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> Cam.w ‘A-/. .3,..e.. . G�,.�.',.,.� wr 5--.3S 2.
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> 6-(i 6- 6/Z 3- Z ? vv U?5". 7/Z .2 ZS- Z applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDR SS
<br /> / - 7`G-T-o/J ,, - ,r�_,(_,,.5 0 Floor plans to scale
<br /> l o�sti
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dene.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL 626. 2 ,02...y. 8,yio V Z''2c o Fe,yJ;7 frontage drawn to scale.
<br /> NUMBER O
<br /> TOWNSHI : SECTION.
<br /> '/a: '/<'/<: ❑ Driveway permits
<br /> L-0,--,/s7ic� G` state,county,( y'town)
<br /> 2-6 f i c' `--12 / -'` ‘1:'.-/-_ ❑ Sanitary
<br /> CSM. LOT 'SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION t STAB r.
<br /> r k. s _PROJECT DESCRIPTION: r�%. ,3 , "X
<br /> '
<br /> • ❑This project is a new building or structure PO D t }�
<br /> ❑This project is an addition/alteration to an existing building or structure. - iAC t °`'
<br /> SANITARY SERVICE: g g ®'A .f ::.t.'0,!.:,-* y
<br /> PERMIT NUMBER: � �� '�, � �ca"3 � :
<br /> ❑SEWER ❑SEPTIC (n'ew/exi n tng'Rz ti, ,
<br /> HEIGHT IN FEET NUMBER OF STORIES (Not including basement) 7 4:!';, '}
<br /> ❑'Wetland/f=Io� d,l'`*.
<br /> Slortei ,�•°f4 a me '
<br /> AREA TO NEAREST SQUARE FOOT: , . b+ rt, ,'
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) _ i '
<br /> ❑ Eroston�o 1 •e ..=-',-;',,;.,:.,.;-.4::
<br /> BASEMENT: 1ST FLOOR
<br /> j TOTAL SQUARE FOOTAGE: 4 (sope ,d 1 4 C o J ar
<br /> fillina
<br /> F 2ND FLOOR: 3RD FLOOR:
<br /> ❑ Rei�liv a ® f u " ,:'-'
<br /> ESTIMATED CONSTRUCTION COST: ♦ -i -. ♦ and ava a•le ®p lens.`
<br /> (Please round to nearest dollar) ,a `}¢iz
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes icro ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Li Yes —o Li Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? s ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? „..-E:ries ❑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 �l,s, ❑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) ■ -► -►
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