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<br /> SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNERINFORMATION .; i; '. . , :: - CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> 74,10e7" 'v/ D����// F C
<br /> .id Zoning Status;CU
<br /> P;
<br /> OWNER ADDRESS Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> ZZ 6 41- .2'71'11.4 y 5 Cy/CA(o /L- 60„3/ variance(# 3f t-7 )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 610_C6 7So 9 PI f Site Plan drawn to scale
<br /> AGENT INFORMATION, i ;. ;CONTRACTOR:INFORMATION.•, '_1.= and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> /❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> PHONE PHONE ❑ Si te roval from
<br /> appli le wnship.
<br /> E-MAI L ADDRE SS E-MAIL ADDRESS
<br /> Floor plans to scale
<br /> PROP,ERTYILOCATION NI OS11,A'LION . h1Et iiiiii essilane CO:dari0411:i s/;1_, ; ,rs= J
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: A Elevation of property
<br /> ❑ NUMBER �S7z .z 5- 4.23 1-zz L 6 frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> LdiO N/ Z$ 1/: 5 ,/,/a: A/a/ '0 Driveway permit
<br /> (state,county own) oic
<br /> ADDRESS:
<br /> 3 412-- L4 E $//02 12. E eNc 6' (,v_Z 1'3 ❑ • ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ( lic,priva
<br /> • 2 G!h' gioC- 7 R-K
<br /> PROPOSED'PROJECtliNFORMATION9R�°, ��i �,:
<br /> ,:.,�t ....��r�:,r�.r.- ,:�'� . ,, .Pi..z`` .-STA.FF REVIEW
<br /> PROJECT DESCRIPTION: A-444***,'
<br /> k-i,?otf6'-f/A/ic. A M/c-y- t/Lo A✓E4l5 fG E�i /1/ ,, nilg asnc
<br /> eKThis project is a new building or structure. }: `'� i?
<br /> p 1 9 M er r fitted Use, fr-
<br /> ❑This project is an addition/alteration to an existing building or structure. r, `, .. :, i
<br /> SANITARY SERVICE: PERMIT NUMBER: ural Address t s
<br /> gSEWER ❑SEPTIC (new/existing) y 1
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) * � ;# rI
<br /> F' '4 -rriC 6-7 Z- 7. 2 P- 2.. 6 etland/Floodplain/,1- z
<br /> - eland (attachment t-,
<br /> AREA TO NEAREST SQUARE FOOT: j4 ; -1, -” �`V; -
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' `1 . '
<br /> ErosionControhperrnit
<br /> �\BASEMENT: 1ST FLOOR:6A�,PO/L-7�Z TOTAL SQUARE FOOTAGE: I IOpes dlstt.rt} 8. ; F:
<br /> µp AIVi Al‘SPAC — /!8'8 � filling%access)' '- ) ,
<br /> SI-
<br /> N2ND FLOOR: 3RD FLOOR: ' J ( ` +,.#�
<br /> Li4/�.✓cf$,"AC6 - 9 eviewl cation SUrveyk
<br /> ESTIMATED CONSTRUCTION COST: c / t and4avallable options'
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ �I' ��.�1 �b 0 I.i 2 ,t "" t• =-, .i4
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? bAq Yes ❑No ❑Don't know
<br /> 2. Is there 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 and are they in agreement'? 54 Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IA No
<br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# 35.1717 ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) XYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? LI Yes N(No
<br /> )
<br /> S C C.C-I(— -. U2 ( I --' • APPLICATION MUST BE SIGNED
<br /> (Continue on Back) –► –► –►
<br /> 545-112(4/08)
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