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• 09/29/2008 10:36 608-267-1540 DANE CO PLANNING PAGE 01/03
<br /> X ` CA--O- IC) SII
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to;Web-App,II,
<br /> ;
<br /> PROPERTY.`OWNER'INFORMATION..! ,, r. _,.!i': :' ,,7+:n _y1}`•a,t a, J'Ln;? '.,. 1'C'l CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> 1c1112 EN Pig 7TE72,5oM + Log. {3e¢v.74 r") ' ► Zoning Status;CUP;
<br /> `,/OWNERAbORESS Number,Street,Cily,State,zip) e ��~ Deed Restriction;CS M
<br /> 3o0 r7 . JVNc71J 5.T 7t9/3evl I Lv i Variance(# )
<br /> HOME PHONE „, PHONE E-MAIL ADDRESS
<br /> 214- 2 4/ 0r., Site Plan drawn to scale
<br /> AGENT INFORMATION,_;;! +t;)CONTRACTOR;INFORMATION!1''wtf j•;;Y and includes dimensions
<br /> AGENT NAME c.2 NTRACTOR NAME
<br /> 14576T-4-14 5/6/r Z/I& 074 Site P an' uding location
<br /> 'AGENT ADDRESS CONTRACT�ADDRESS of wel p•
<br /> , C.s' -11611=6 r e 4: i2t0 ,m.,,4,
<br /> VCity,State.ZJ. (C•, te,Zip) 2/O�f • $-5
<br /> PHONE PHONE A Site Pia proval from
<br /> .,: 237-if- -',5,. t 11 a 6-,4,77/ appal ie township:
<br /> -MAIL ADDRESS E-MAIL ADORE b
<br /> �1'jrC t9 0,ery2?-4, ”- Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION':',(http://accessdarte co;tlanawA Usl), 11, i <. c''
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property
<br /> nNiUMBER •'-/o- o53-o26S�-7 �- f AC r>{„ frontage drawn to scale.
<br /> TOWOvHIP: sECTIO .
<br /> ivp i %: 'J WA: 1J.E v .Drive ermits
<br /> ADDRESS:
<br /> (state, nty,town)
<br /> 30017 (�ANN o NI 5 / / !('/"1,56!4t sa • ennits
<br /> OSM: LOT SUBDIVI It a.%v BLOCS/1AT
<br /> , • (publl , ' ate)
<br /> N,ltxv , .. c:c.
<br /> PROPOSED PROJECT INFORMATION, , i '' ' , i. _ i .''' l ' S rya nom )��),hr'';;.',};';
<br /> PROJECT DESCRIPTION: /�/ J p t r r
<br /> L'Vu 10Z -1,s '�- So �:- V I"— f 4 (' 1, i1'i r , ', _'i .
<br /> l,,,,-,-2-,::. f J
<br /> ❑This project is a new building or structure. ta ,-0 .' ', ' iy '.-A10,-.,�i i
<br /> .This project Is an addition/alteration to an existing building or structure. r.,,,,,'4:, ,,", ,ti/dit j
<br /> SANITARY SERVICE: PERMIT NUMBER: ti 7::�� 4k.1i °a'i {+., � i
<br /> ,.SEWER ©SEPTIC \ A ,, '1` I' -)r c ° i
<br /> HEIGHT IN FEET NUMBER OF S '-I S: (Not Including basement) '4 i a
<br /> 1
<br /> -r
<br /> AREA TO NEAREST SQUARE FOOl
<br /> „ e t)lt� rIr',1` 7 r rc 4,:4Ju y.^,I
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ti' ' ` Tr, 0-'i,:'
<br /> J
<br /> BASEMENT, 1ST FLOOR: `7'
<br /> 4, TOTAL SQUARE FOOTAGE; ,� /,, r '.�icl e' >,.et1 I. }y° _1/. *4..
<br /> 7'! t.l ititi�t. f,:- )
<br /> ,2ND FLOOR: aRb FLO V 1 '-4'`
<br /> EF , lt"
<br /> h;ic�-.12"' f4V
<br /> ESTIMATED CONSTRUCTION C05T -0, -+ -} -► 3 -► $30 DO0 L:,.;ar' 1t�v`j an i"iii ( " ?j
<br /> (Please round to nearest dollar) ;. u1�, -21.L.1
<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 floodplein on or near the property? ❑Yes -No J-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 0 No
<br /> 5., Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. 1s a location survey required? (see reverse) ❑Yes alio ❑Don't know
<br /> 7. Is this to correct a violation? El Yes At No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continuo on Back) -+ -9. -F
<br /> 545.112(4105)
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