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ZONING PERMIT APPLICATION www.countyofdane.com ,,SUPPLEMENT to Web•App#
<br /> PROPERTY.OWNER iINFORMATION �; : .. tip ,11 4 '+: .4i ,M: -_. ,; : ( CUSTOMER TO PROVI P
<br /> OWNER NAME �Nj ear` Cvn 1,4,C„)./007
<br /> ' t Zoning Status;CU' ', r)
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) '-'t Z3 1' (ke.9-lSlce 4..6-5 k,'i�.",9 Deed Restriction;C ,I
<br /> M - ll- - . ..__ ---.rt 3 Z`• 1 Y Variance(# ) r" 0
<br /> HODOE.PHONF.4,A. CELL PHONE E-MAIL ADDRESS
<br /> - f , - 11°Z 7 Sit C € �"_3�) r' Site Plan drawn to scale f /
<br /> AGENT INFORMATION CONTRACTOR INFORMATION '` -nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 0,)740.4. ccytgti:{c4►rh 1.d Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic / / 3S 3 7_00
<br /> alz) 07 i-P u Li.,',-#)v y
<br /> Zip) .i sea, �,.r 30 /0 /A �7
<br /> (city,state,r (City,State,Zip) '!'d Setbacks
<br /> PHONE PHONE '`T 5 3 7/' , .Site Plan approval from •
<br /> �Sf- /?)02- 751171 applicable township: � '
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> e�k7k Qc,7c�c1�r. � , Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION;.,(http:l/accessdane.co.dane.wi.usn 1 r !?�
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: j�� Elevation of property L
<br /> ❑ NUMBER C aC. , . 31°.- c°13� r{ - 1/9-j� • frontage drawn ttoJ scale.
<br /> TOWNSHIP: SECTION: Lo 4- //00, — 11 Z
<br /> 5prSS: fe.v 31 1/: >/i/E 1/4%: y. to Driveway permits
<br /> ADDRESS:
<br /> (State,county
<br /> 15/L1 Rti14'kr? o1- T1a') 6Sanita ::-nits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public )
<br /> 3 L1j.k Cu:.</4-
<br /> PROPOSED PROJECT INFORMATION :`; , ,. 1�,, e7)f
<br /> PROJECT DESCRIPTION: i,,y } rIQ
<br /> Arcs S F ). .. 0 ,- 7�
<br /> S� � !� ¢rte. �-�5, •e.r� �?C�� � -�'r� � � �`
<br /> his project is a new building or structure. v-,..;„----,----;::-,,,--
<br /> . •i;;_a, , -,=.:,..- r,
<br /> CI This project is an addition/alteration to an existing building or structure. j= f
<br /> SANITARY SERVICE: �� PERMIT NUMBER: J °°. ', {•❑SEWER LR SEPTIC ,1 .. :"..---'-',74
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) t��
<br /> ?i _ � +tg"' ' - 4l. . Y ,
<br /> l i a . f �
<br /> AREA TO NEAREST SQUARE FOOT: /
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , i �r" °i 4 g /► p
<br /> BASEMENT: 1ST FLOOR: �5 ` t
<br /> 1, TOTAL SQUARE FOOTAGE: 1 s 1. t ,, . #7
<br /> 2ND FLOOR: 3RD FLOOR: 1
<br /> 1 _ C-_ 7 3 L
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ��C _ m g 4 9�1
<br /> Please round to nearest dollar ,>
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? acs ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes litflo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? des ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C' to
<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 ago ❑Don't know
<br /> 7. Is this to correct a violation? i - MI;
<br /> ■
<br /> 1,.. /JSO O'
<br /> O0APPLIC• % MUST BE SIGNED
<br /> 545-112(4/08)
<br /> llll((((�000 C• ue on Back) -0. -0. -0.
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