|
•
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENTto Web-App#
<br /> PROPERTY OWNER:INFORMATION ._ ,_ , .d :w41i ,;::, .,_. ^{ CUSTOMER TO PROVIDE
<br /> OWN1/1111/ f-/NAME, / Q
<br /> t�1 L l'I N✓'�f S
<br /> ❑ Zoning S s;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) De estriction;CSM
<br /> 59'3 Q Scti,c„-,, Rd (ro SS ,- ' 5- 41/s - Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ‘o •,.j 7 7 6 O 5 , .7-U3.2-9e, Si Plan drawn to scale
<br /> AGENT INFORMATION ; CONTRACTOR INFORMATION 1,•::-... nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Q S'a Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/setic
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> PHONE PHONE Cl Site Plan royal from
<br /> ppli le township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> F or plans to scale
<br /> PROPERTY/LOCATION:INFORMATION .:(http:l/accessdane.co.dane.wi.usl) ? , Elevation of property Gil PARENT PARCEL NUMBER: CURRENT ONING: ACREAGE: P P rty
<br /> ❑ `� /!�C 6 o, frontage drawn to s .
<br /> PARCEL
<br /> NUMBER 0807"/D y 4
<br /> TOWNSHIP: - SECTION:
<br /> B,rr y 0 1/4: 5 E 1/1/. ,SF ❑ Driv y permits
<br /> l
<br /> ate,county,tow.)6- 9
<br /> o 5 C- k ••'U R
<br /> ❑ Sanita •ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (p c,private)
<br /> PROPOSED PROJECT INFORMATION, ' -'
<br /> PROJECT DESCRIPTION: t '-r t
<br /> ❑This project is a new building or structure. E: '. s'
<br /> 1 This project is an addition/alteration to an existing building or structure. ` ti ,'
<br /> SANITARY SERVICE: PERMIT NUMBER: f i tr
<br /> ❑SEWER ®SEPTIC 4. - -4
<br /> t -
<br /> HEIGHT IN FEET 1 5 NUMBER OF STORK: (Not including basement) �� ��� ,
<br /> AREA TO NEAREST SQUARE FOOT: �� , f'
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) u- I
<br /> BASEMENT - 1ST FLOOR: a ®� 4� �� �
<br /> a 4 TOTAL SQUARE FOOTAGE: j �
<br /> " E, 4-- ,fg, m�'v (, f, ( 1
<br /> OA'o a ^ cs K
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> —1'6-0 0),.,. (61 k4.--- --F-- -_,'.-,- ,-_--7:7,:,-, _ , 1,,,,ft.:,i
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) -* -* -* '" $ 8 0e 0,dy � i o '`� #
<br /> a.4t r .*mss i;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? V es 6-c.:1 ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Wes No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? rw-c,(Yes ❑ o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 31137
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank ne)
<br /> 6. Is a location survey required? (see reverse) ['Yes N ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes o
<br /> 4coci APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4. .► -►
<br /> 545-112(4/08)
<br />
|