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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER:INFORMATION �;; ,Z .;',;-3 4,0,,,,; 42. !,Yt: . OUST.'MER TO PROVIDE
<br /> OWNER NAME /
<br /> A ' `/ /T R b'e_rk o r'\ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> y 9 G Z 4 er'Le V i //e ,(;) e-e/ /kye- 6-1'vve 1,,._L Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 5)5-2.-7
<br /> " 3-'1 36 LI / ? ite Plan drawn to scale
<br /> AGENT INFORMATION -;: : CONTRACTOR INFORMATION :: and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 0 w ■e r . Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of /septic
<br /> (City,State,Zip) (City, Zip),State,Zi l.J Setbacks
<br /> PHONE PHONE ■►/k le Plan approval from
<br /> a-plicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ? `'' 3
<br /> Elevation of
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property
<br /> PARCEL BER b 5$'/ o
<br /> g)j-3sI-930. R P- 1 I o E frontage drawn to scale.
<br /> NUM
<br /> TOWNSHIP: SECTION:
<br /> Su A pra.,'rl'e_ 35_ 1/: NE 1/A: S tA/ VAcieway permits
<br /> ADDRESS: (state,county,town)
<br /> U 9 b k.- P)e r C e U, j)e R c I/is.. itary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 0 3 3 .a 1 (public,private)
<br /> PROPOSED PROJECT INFORMATION,
<br /> 4,,!
<br /> F
<br /> � ;, .',�- FL- 111-7,4;.PROJECT DESCRIPTION:
<br /> f' I % p s‘ 7^0 Q�T u i / 1 r f l�jl x 4
<br /> ' .✓ O�� r1 ,
<br /> ❑This project is a new building or structure. . r-g , -k
<br /> Rfhis project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ® " F-1, ;"< 4
<br /> ❑SEWER �∎ SEPTIC - -; a�= = � ,'
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) .��,�_,� < r.
<br /> ,a p se li f kt:
<br /> -AREA TO NEAREST SQUARE FOOT: `, ,.��: %
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) < - y
<br /> �, 1 V r1�
<br /> BASEMENT: 1ST FLOOR: , 11-- � a "'
<br /> ,l, TOTAL SQUARE FOOTAGE: ,,,
<br /> 2ND FLOOR: 3RD FLOOR: [1:,;51-$0 i
<br /> - , a'' 't ,j o o g 3 0°,. a OK 4
<br /> ESTIMATED CONSTRUCTION COST: -► -► -i Q� itiar A_(Please round to nearest dollar) .p 5-;� 30 p 0 :.
<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? ®Yes Li No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# X03(4leave blank if none)
<br /> 6. Is a location survey required? (see reverse) LI Yes ®No LI Don't know
<br /> 7. Is this to correct a violation? Cl Yes CNo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -1 -► -0
<br /> 545-112(4/08)
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