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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web-App#,
<br /> PROPERTY OWNER;INFORMATION w=: ' ';' L .?Y�,,,, -., 4 t+-::-$1:2-1-......, CUSTOMER TO PROVIDE
<br /> ()AVER NAME
<br /> fl 06 er/L 11'7C,'7 hi C' ,e'• ❑ Zonin Statu • P•
<br /> OWNER ADDRESS (Number,Street, ty,State, g '
<br /> "� eed riction;CSM
<br /> 2 3 7& fil h d?b'9 ✓�c ( c 1 f o�c �Jrvi/c �"v 3:,7,3-2 7 ' nce(# )
<br /> HOME PHONE CELL PHONE E-MAIL E-MAILA ADDRESS
<br /> a is - r 3 • Site Plan drawn to scale
<br /> AGENT INFORMATION>;:: , CONTRACTOR INFORMATION'. 2 and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> s C i e n < A C , G"C U e,r tv.,/0/C c,,fr n, % ❑ Site Plan including location
<br /> "AGENT
<br /> ADDRESS CONTRACTOR ADDRESS �
<br /> f well/septic
<br /> AruerswoId CGf.sf-oiik► L--X)-fr%-r/ .✓0 /1c:,,,;,L/e-, S f— -
<br /> (City,State,Zip) (City,State,Zip) i Setbacks
<br /> 5'fc4,r,,11>✓ci /1/i 5s' .-f7
<br /> PHONE PHONE ❑ Site Pla p oval from
<br /> ?2 - S'‘1;2- 2 applic I ownship:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ loor ans to scale
<br /> PROPERTY/LOCATION N:INFORMATION (http://accessdane.co.dane.wi.usl) Elevation of property PARENT PAR EL NUMBER: p CURRENT ONI G: ACREAGE: P P rty
<br /> ❑ PARCEL O Co/I„ ©�y„ 7 QO 1 .R N f a frontage drawn to scale.
<br /> NUMBER 7 7 lI
<br /> TOWN I t SECTI �.(` ❑ DrIVeW permits
<br /> �'t kS G va C'I v\ 'A: 1 IA: E. sri ,cop town
<br /> ADDRESS: r ( ty, )
<br /> 3 : t 'e vl RA ❑ Sanita •ermits
<br /> CSM: ts1 ` O LOT ' SUBDIVISION BLOCK/LOT (pub('',private)
<br /> PROPOSED PROJECT INFORMATION;
<br /> PROJECT DESCRIPTION: r . , z -7+ -
<br /> C �/ F � °k
<br /> �,,
<br /> LThis project is a new building or structure. „„_ - -4
<br /> ❑This project is an additio /alteration to an existing building or structure. ;1,,,,..,k<
<br /> SANITARY SERVICE: PERMIT NUMBER: P s n .-
<br /> ❑SEWER 'SEPTIC s,I�t LK '.
<br /> HEIGHT IN FEET:• , NUMBER OF STORIES: (Not including basement) , `
<br /> /
<br /> AREA TO NEAREST SQUARE FOOT: ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) i`
<br /> BASEMENT: 1ST FLOOR: , a �.-.1-'!'6- ti.,
<br /> - l \ • TOTAL SQUARE FOOTAGE: ,, - ..)0 goy '
<br /> 2ND FLOOR: 3RD FLOOR: n
<br /> 7 vI ,
<br /> ESTIMATED CONSTRUCTION COST: ,� .r ' - z® ®stt b.
<br /> (Please round to nearest dollar)
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes [E‘o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? LI Yes L7 No LI Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes LI No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Q7<lo
<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) aces ,C3,/NNo LI Don't know
<br /> 7. Is this to correct a violation? ❑ �
<br /> Yes l�No
<br /> ( c APPLICATION MUST BE SIGNED
<br /> f (Continue on Back) -► -► -■
<br /> 545-112(4/08)
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