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<br /> ZONING PERMIT APPLICATION www.countyofdane.com .SUPPLEMENT to Web-App#.
<br /> PROPERTY OWNER!INFORMATION . 4=;_;; , - V �r�?0 „- . :•j :, CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> I/.YOiit')/ 'ILloti r/�ay'LA �s_lr U
<br /> OWNER ADDR S (Number,Street,City,State,Zip) CI Zoning Status;CLIP;
<br /> /, -q/ 1--L4/rte/ve DA e-D� aAJ 4)/ ,S��-3.,� Deed Restriction;CSM
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE
<br /> E-MAIL ADDRESS
<br /> ilO4¢"ecf--- 'Carr - 0'1/7 i'9d i 77 C�o.eG.,' /cf-9G @ 4/0100. (..-•"--, ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION - CONTRACTOR:INFORMATION `` ' 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 ❑ Site Plan approval from
<br /> applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION • (http://accessdane.co.clane.wi.us/) ;.
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL , ' frontage drawn to scale.
<br /> NUMBER vZ/'k7/2^�—s�-.��ZZ� �� g
<br /> TOWNSHIP: / SECTION:
<br /> /4 /-, c/ '/<; <� /�/; .w w CI Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 7e 9v9/4 . S'T z-zi ,,.e r e,c) et,/ S 3.S,J°y
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> ❑ Sanitary permits
<br /> /-3 r (public,private)
<br /> /c„). 66Aart,,../
<br /> PROPOSED PROJECT INFORMATION, TA :
<br /> PROJECT DESCRIPTION: ��
<br /> ❑This project is a new building or structure.
<br /> ®This project is an addition/alteration to an existing building or structure. Lf' -- -
<br /> z,.
<br /> SANITARY SERVICE: PERMIT NUMBER: Oc��,�$°ci� �' � -:'¢V..
<br /> ®SEWER ❑SEPTIC ',k „ a. it.4 s, ' '-'
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) -- _--,_„7.:-:::,:„,"
<br /> V' ,® '476 j .. r` n
<br /> AREA TO NEAREST SQUARE FOOT: , ‘V".'4,47',V V ,'iV V
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) klt
<br /> BASEMENT: 1ST FLOOR: sum e
<br /> C) ?ao j, TOTAL SQUARE FOOTAGE: 4, , 5-t a�,L-! t
<br /> 2ND FLOOR: 3RD FLOOR: f° FA VI
<br /> O 6
<br /> " `,:r `,s" ;, f
<br /> ESTIMATED CONSTRUCTION COST � � a b 4:-
<br /> (Please round to nearest dollar) -4* '"'� '"� --• —IP "'► $ /606 sts �
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 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'? ❑Yes No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ER Yes alNo
<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) MYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ®No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) —► —• --.
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