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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER:INFORMAT,ION..4'41: _ ,'., 1 'a ::::=4,,-..1',..,- :;:t-31:::=13::? CUSTOMER TO PROVIDE
<br /> O ER NAME
<br /> pc,6 1/." - -' f Am 1 q ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) l Deed Restriction;CSM
<br /> S 0 eq 00'4 v-1 I?/1 adi36 :.. w/ ,S370 V Variance t )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 4e 2 /--- •- ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR;INFORMATION':' -1,;::',2 and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME ,p
<br /> 5r05wa,-tfri /�r,,iOb ( S ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> JO4,4sAQ// w / 5`.,?5_ry
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> G dr .5-2J-----_.70 . applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS r
<br /> /Y7•I ri j /o/t ® a'a/,C art ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION ':;(http:l/accessdane.co.dane.wi,us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL -, / -, -) frontage drawn to scale.
<br /> NUMBER U/ d
<br /> TOWNSHIP: SECTION:
<br /> Sv 4 Pro r,e 5* ,� /: � E %IA: S 4i ❑ Driveway permits
<br /> ADDRESS:2 g�/ y (state,county,town)
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION, i
<br /> PROJECT DESCRIPTION: / L , �
<br /> hew g', .4-a• ' vi-- 8.rQ f00 11PnNV I/e_Spifea►-t ��i , ; -
<br /> ❑This project is a new ."ilding or structure.
<br /> — s
<br /> f7his project is an addition/alteration to an existing building or structure. ,.a 4 Y
<br /> c .' e -
<br /> -q z SANITARY SERVICE PERMIT NUMBER: ' '' " r❑SEWER SEPTIC � .'
<br /> T..
<br /> ".1:'
<br /> .
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) z � fi . ' A
<br /> AREA TO NEAREST SQUARE FOOT: , �, , c . , V
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �4 ` "
<br /> BASEMENZ 1ST FLOOR: s e s °: '
<br /> l// �- 4, TOTAL SQUARE FOOTAGE: 4, • .0" „ ,i,:
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ' ' / L.---- : _ z,',%
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ a e r . ..
<br /> (Please round to nearest dollar) $ /QO °CC► •• `-
<br /> d�._LLr.c`A x 3n:"�""i3.�'��s'.:n S... .. ..,.ky,[r
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes X No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes pNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes M No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No --7
<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 ❑No WDon't know
<br /> 7. Is this to correct a violation? ❑Yes ATNo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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