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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#:
<br /> PROPERTY OWNER,INFORMATION„ z, -Z:,4",-.:141:I4 .00%-1_ . > t - CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> kIR4DIGrM (oMMVroIt4T1on4S I / t G. Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 2 3 of ICELp G' -(>4.,1/E J U 1f LE C4tvTe- Ldl s'41y0 Variance(#CAP 1 671 )
<br /> PHONE (JO tJ4. HONE lF E-MAIL ADDRESS �1.�1I
<br /> Zo- of•7•IS • 2a-681-az9 ' rei I` 6454-elAwlftlessd eF Site Plan drawn to scale
<br /> AGENT INFORMATION. . CONTRACTOR;INFORMATION _ and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 1 bOP PLA-554( -ThWeYI.,^["tECI;n>cutoigs 601P 'Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> Pri132 P01 'NAVE P.o. 4oX Z66
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> $ELtrl of LLE, W 1 S3Co8 ED[ -2T•I.j wI S3S3`/
<br /> PHONE PHONE I ❑ Site Plan approval from
<br /> `O9-4 2'{-34 Do k Iii toe- 843- ggy I applicable township:
<br /> E-MAIL ADDRESS I E-MAIL ADDRESS
<br /> t• - 41, I u sc Sir- <<4k 4e' 'k S.46 M '1"4-• .^4 a -.46,( . ii Floor plans to scale
<br /> PROPERTY/LOCAI ION INFORMATION (http://accessdane.co.dane.wi.us/) ,
<br /> SNirPARCEL
<br /> PARENT PARCEL NUMBER: •• ' CURRENT ZONING: ACREAGE: Elevation of property
<br /> NUMBER 6 1 1 o i. i 6125-3 4-I EXi 4-a 1 : 4 LI frontage drawn to scale.
<br /> TOWNSHIP: SECTION:P4 • N04,ap lu_71 o
<br /> 0 Loo�►A I N(7 GAIN 6 T ,%ixr: I'1 Driveway permits NI�
<br /> ADDRESS: (state,county,town)
<br /> 4343 Coj,rTy I'hvW. 46 moots-on S31041 CSM: LOT SUBdIVISION /BLOCK/LOT unitary permits IA,
<br /> private)
<br /> PROPOSED PROJECT INFORMATION T
<br /> PROJECT DESCRIPTION: � t- .;� �I�
<br /> 'IPJ I •fJ .. "I MAC 4 L rI • EQUIP • .,. 1 'J * s.�r� �,,
<br /> LI This project is a new building or structure.
<br /> This project is an addition/alteration to an existing building or structure. ,:',-'_:,:44.:L .
<br /> SANITARY SERVICE: PERMIT NUMBER: ' t e ,
<br /> ❑SEWER ❑SEPTIC pone N A , . rr
<br /> HEIGHT IN FEET: 1 N(f 1901 NUMBER OF STORIES: (Not including basement) - `
<br /> s ,
<br /> : • Jr • • : J NJ 4 901 Is Inv -, r �.�
<br /> AREA TO NEAREST SQUARE FOOT: * �� :�e
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a
<br /> BASEMENT: 1ST FLOOR: —� €,,�
<br /> e e ogee
<br /> ,, TOTAL SQUARE FOOTAGE: ,I, • e aii' xx
<br /> 2ND FLOOR: 3RD FLOOR: lik
<br /> �T '
<br /> OVTOoog- eQu1�,
<br /> - =m "✓ ` , w ';' ?. tee
<br /> N q x /01z I Aperigt lw r �q �:
<br /> ESTIMATED CO STRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ -- $ , 0 . 6D i _
<br /> (Please round to nearest dollar) $ 11 ZI __ , ,- --i i.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes =4 No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? EYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? t'es ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#CUP 1n, ) , (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> 545-112(4/08) 4310) _ APPLICATION MUST BE SIGNED
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