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<br /> ZONING PERMIT APPLICATION www.countyofdane.com .;SUPPLEMENT:to Web-App#:
<br /> PROPERTY OWNER INFORMATION,.�; _ _ '�, 1 ;;;a,��,� _ .�,_ , t., : P:
<br /> o E3 NAME = CUSTOMER TO PROVIDE
<br /> J�a0 e,- f ill an f v'1i eK ❑ Zoning Status;CUP
<br /> OWNER ADDRESS (Number, tree ity,State,Zip)/ Deed Restriction;CSM
<br /> �
<br /> .2 ?/ it?, h ' /') /^r//- at Tgr�jj---c ',�r1 ' 3332 ' Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADGRESS (
<br /> S _ '6 A ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION. :: CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> AGENT ADDRESS �A . &o '—i ❑ Site Plan including location
<br /> CONTRACTOR ADDRESS of well/septic
<br /> /a CC //a/w./f 1
<br /> oh s
<br /> (City,State,Zip) (City,State,Zip) Li Setbacks
<br /> PHONE PHONE ✓ • Site Plan approval from
<br /> '7 7— fC;2- j applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION '::(http://accessdane.co.dane.wi.us/) ,'
<br /> PARENT PARCEL NUMBER: Cu RENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ NUMBER 0t;"l 1--0 y/I —0 yo5 A 1 l------ X frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> , , ❑ Driveway permits
<br /> (-c4 seahfi- pr;hy 5 ,/: ii:
<br /> RESS: / (state,county,town)
<br /> 5 6t h' `�
<br /> p ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION,
<br /> PROJECT DESCRIPTION: )"°TA ' n s
<br /> A el .' 011 ' 'C . . ir.1.-. ..*-:•7?>'' : " --:, ,":,,,-,,;.-,,, `1*--,4-
<br /> ❑This project is a new building or structure.
<br /> Li This project is an addition/alteration to an existing building or structure. : ,---X : :� r ..,,,4-'-t.:'
<br /> :K4',•::71-,,:,,.;, ,,,..,.:,
<br /> SANITARY SERVICE: PERMIT NUMBER: tz I' _ '
<br /> ❑SEWER ❑SEPTIC ) ! �
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) . _ .- s --
<br /> I AREA TO NEAREST SQUARE FOOT: ,,` °,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � tx:,,
<br /> BASEMENT: 1ST FLOOR: k -e ®R
<br /> i
<br /> 4, TOTAL SQUARE FOOTAGE: 4, a a[ ' ,.` t .:
<br /> 2ND FLOOR: 3RD FLOOR: _' r ;� �'�
<br /> .--T-,-',';',,";:
<br /> 0:1140:43 .7.6"*.-:".,.-
<br /> ESTIMATED CONSTRUCTION COST: ® I e t e i ,-V
<br /> (Please round to nearest dollar) -. -+ •-0 -9. '� , -
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes E No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes !+N ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑,Y 2.6-o 4. Has there been a zoning permit issued for this property in the past 5 years? Li1Yes ❑No
<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 C 91cro ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes lLd'No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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