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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION.n, _ '' '. ,�,`.r'��;� , ,, ,�._. .. �., .-.
<br /> �/�`- _• -� CUSTOMER TO PROVIDE
<br /> ER NAM=1 1 W
<br /> ill AL A.V 0 `' /i41 ' 4 I Rai F Zoning S�a�tus Cl�P;j�h `
<br /> ir , �� ��� rI��� •eed Restriction;CSM
<br /> 'r 111r t/ Variance(# )
<br /> 11J/3/J.73'OS i Or f ELL PHONE E-MAIL ADDRESS
<br /> 91-"Site Plan drawn to scale c'-
<br /> AGENT INFORMATION CONTRACTOR;INFORMATION t ;i and includes dimensions a C '
<br /> AGENT NAME •• -.�� �- . ' / !,e
<br /> '( , , /L; 4Site Plan including location
<br /> AGENT ADDRESS •. TO-ADDRESS of well/septic
<br /> f • -, .i
<br /> (city,State,Zip) ji" • , (Setbacks
<br /> PHONE PHONE i .G4\Site Plan approval from
<br /> 742 t J applicable township:
<br /> E-MAIL ADDRESS E-MAIL ESS
<br /> 4'Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION ::(http:l/accessdane.co.dane.wi.usn Elevation of PARENT PARCEL NUMBER: CURRENT ZONING: A E: oproperty
<br /> • L NUMBER C)50-7 0 0(30 s ol G( - frontage drawn to scale.
<br /> T SKIP: SEC;�' : `
<br /> 1/4:5 1/41/4: , L. riveway permits
<br /> 4 '
<br /> = Y (state,county,town)
<br /> 11E„; �4 ,
<br /> cs � SUBDIVISION BLOCK/LOT
<br /> Sanitary permits
<br /> (public,private)
<br /> PROPOSED PROJECT.INFORMATION, :; - 7 7T a w
<br /> P-O at •ES•-I TION:
<br /> .`u. . ,J • .. Ill-....� ,.:. Al. �1►_ � 3
<br /> 14 This project is a new building or stru 00 r- � - #§ze4. g r ,, ;
<br /> ❑This project is an addition/alteration to an existing building or structure. � 'r -1
<br /> F $�
<br /> SANITARY SERVICE: PERMIT NUMBER: � ° P ,'-.,;`,:::',17,-.4,
<br /> ❑SEWER ASEPTIC l'443.77 -`,. *OrE°s °a
<br /> HEIGHT IN FEET: S NUMBER OF STORIES: (Not including basement) ®g ° ,
<br /> AREA TO NEAREST SQUARE F•OT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -i _ ` �y
<br /> BAS ^y 1 ST �Q • e! S �l-p- o ,
<br /> 1 J i �i `1 7� 3 r/) ( ,, TOTAL SQUARE FOOTAGE: 4, , , , I.:aa,E �Y„l
<br /> 2ND FLO • 1.� 3RD FLOOR:JJ/ t'J"►--, - � , ) i7
<br /> C
<br /> v t :74 ?.' arf . •
<br /> t ' ,� -,
<br /> ESTIMATED CONSTRUCTION COST: 4
<br /> (Please round to nearest dollar) -► --► --► -'0- '♦ ♦ $ j a._.�,-x=, ®� ,,,,,,9,
<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 VI 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? ❑Yes 41 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 ❑No 2A Don't know
<br /> 7. Is this to correct a violation? ❑Yes -0 No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -I.
<br /> 545-112(4/08)
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