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-ZP 65
<br /> ZONING PERMIT APPLICATION www.countyofdane.com :SUPPLEMENT to Web-App#
<br /> PROPERTY.OWNER`,:INFORMATION J ;;- ? ,�,�, ,:• ..�._: !,?;: °`; CUSTOMER TO PROVIDE
<br /> OW NAME / � ..
<br /> C>ME 9 L D (c. �C'oJe
<br /> OWNNERADDRESS (N mb Street,City,State,Zip) ❑ Zoning Status;CUP;
<br /> .0 (303 ^vi J Deed Restriction;CSM
<br /> er�S�" LJ Variance(# )
<br /> . HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ' 7 —Nil il 6cT Of, -7 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR;;INFORMATION`: and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> deo,c'U
<br /> i `"/ r-
<br /> Z �,',S4 -uG4tArt 6,,,,e_ , ae,—^ ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS .J of well/septic
<br /> a4aa-7 s. 5 -0.4 0 P.�
<br /> (City,State, ip) (City,State,Zip) ❑ Setbacks
<br /> Mo. �s0-1 537th
<br /> PHONE�/
<br /> PHONE ❑ Site Plan approval from
<br /> –9XCX) applicable township:
<br /> E-MAIL ADDRESS I t E-MAI}.ADDRESS
<br /> Cle,0 v) P,,,.,_ be,,.a'7bbc-tt - totAttne-r ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION<':(http://accessdane.co.danewi.us/)
<br /> PARENT PARCEL NUMBER: CURRE ZO("ING: ACREAGE: ❑ Elevation of property
<br /> ❑ NUMBER Oil '013'4'-3 1 , 6 frontage drawn to scale.
<br /> TOWNSHIP: C ION:
<br /> 8�' -�-0 ' SEC ,/: W W ❑ Driveway permits
<br /> AD2RESS: (state,County,town)
<br /> c. 610.. , LoT Jr1 J SUBDIVISION ❑ Sanitary permits
<br /> 3 N BLOCK/LOT
<br /> r e�,s.e.... 3 (public,private)
<br /> T1
<br /> PROPOSED PROJECT INFORMATION, � ��x Y
<br /> 1 PROJECT DESCRIPTION: . t r t
<br /> 0 ee.14 � ?
<br /> x - -
<br /> This project is a new building or structure. 7.� g' -��
<br /> ❑This project is an addition/alteration to an existing building or structure. s r ,'
<br /> SANITARY SERVICE: PERMIT NUMBER: �� e � ' ��V�
<br /> �
<br /> t T
<br /> ❑SEWER ❑SEPTIC .,,_. ,
<br /> HEIGHT IN FEET 1 t NUMBER OF STORIES: (Not including basement)
<br /> AREA TO REST SQUARE FOOT: �� � .�° : ;
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) k ,�°
<br /> BASEMENT: 1 ST FLOOR: � � s IL_ ,,IP . t
<br /> I �' 3 TOTAL SQUARE FOOTAGE: I , "�r Vr .
<br /> tp 1
<br /> 2ND FLOOR: 3RD FLOOR: (()L,- 1 ' :-
<br /> ,ate, �,,Ltlfit° mF 12,Nw .0.,E
<br /> ESTIMATED CONSTRUCTION COST -. -+ -► $ 7 000 � i '��� # .
<br /> Please round to nearest dollar
<br /> t
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 81No ❑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? EYes ❑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 ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes Z.irio
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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