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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# ��-��
<br /> PROPERT ' OWNER INFORMATION -x;,....-..,.® ®� '
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<br /> OWNER NAME s '
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<br /> OWNER ADDRESS (Number,Street,City,State,Zip) - .
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<br /> PHONE E-MAIL ADDRESS . A 4
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<br /> AGENT INFORMATION CONTRACTOR INFORMATION Died B strl:tiQn ; 1r ,
<br /> AGENT NAME CONTRACTOR NAME �.` -
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<br /> AGENT ADDRESS CONTRACTOR ADDRESS ``
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<br /> (City,State,Zip) (City,State,Zip) 1°ft'?'W ,, -
<br /> 3 5-5` &10vv4 4 € 417- 5`1 S'S I ` a
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<br /> E-MAIL ADDRESS E-MAILADDRESS ` -I®-
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<br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) j 4 :0746 6TO',:_.:"%,G—.,:,
<br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: aUl ,;4
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<br /> D PARCEL NUMBER d`l/l O 3” YcC J-O /i �/ • 7G r s-� .,
<br /> TOWNSHIP: ` 4q k
<br /> /n� SECTION: (, ;y -. i
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<br /> ADDRESS: a 410, ,
<br /> 66 yC_ J t 24 /� ,r.v 7,c.v, E � � �
<br /> CSM: L•T SUBDIVISION BLOCK/LOTxa
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<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION:
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<br /> ®This project is a new building or structure. i ® '�' 0r :
<br /> ❑This project is an addition/alteration to an existing building or structure. '
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<br /> SANITARY SERVICE: PERMIT NUMBER: "' -rvn
<br /> CI SEWER El SEPTIC 5-7 5Zi U �,,, .s "- t. - -
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) s a`) Ys r 7 ; ° :
<br /> AREA TO NEAREST SQUARE FOOT ''
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) q l ® 7 �� ® z
<br /> BASEMENT 1ST FLOOR: *
<br /> S ,, TOTAL SQUARE FOOTAGE. ,, ,
<br /> (7317 r a -
<br /> 2NDFLOOR: 3RD FLOOR: a -- �- '
<br /> R( „ �MITI ems
<br /> ESTIMATED CONSTRUCTION COST: - t .�n� s7/4 1 ,
<br /> (Please round to nearest dollar) --► 1 ° �� PRA .
<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. There is 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? Dyes 121 No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? @Yes ❑No
<br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) I-. - blank if none)
<br /> 6. Is a location survey-required? ❑ es ❑No a Don't know
<br /> 7. Is this correcting a violation? • Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -0 -► -►
<br /> 545-112(1)08)
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