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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT.to Web•App#
<br /> PROPERTY OWNER.INFORMATION:4�;-: ,?_ ;'-1 ',td c aA-=',. L- t,;?f=�"` CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> fri aik (A_,:l 0,,A,s .
<br /> ❑ Zoning Status;C
<br /> OWNER ADDRESS (Nu7rq er,Street,City,StateAp) n Qn
<br /> 53 S'5 h3 r-J Vie, 15 0 -K6 Cu—Pc-c,;n t (NS 5351 eed Restr' n,CSM
<br /> avian )
<br /> HOME PHONE CLL PHONE E-MAIL ADDRESS
<br /> 6o6 5 -18 d©$4��+ go w i 6 Li j III ass e Veri204. 4e4 Site Plan drawn to scale
<br /> AGENT INFORMATION .. CONTRACTOR INFORMATION`?? d includes dimensions
<br /> AGENT NAME I CONTRACTOR NAME
<br /> f 4 l )s l i t`awts Sit: -Ian including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS o' ell/septic
<br /> 53S5 16(Oke,. aa.-.) ;
<br /> (City,state, ip) (City,State,Zip) I Setbacks
<br /> S At& Prvi rt Nj-1 53s[o cc�1
<br /> PHONE/ PHONE ❑ Site Plan royal from
<br /> 6O g 8 O.if rg appl' le township:
<br /> E-MAIL ADDRESS i E-MAIL ADDRESS
<br /> S I/J1,t w 5Q,Veil2,0A- vik,f oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION ::(http://accessdane.rra dane.wi.usn! levation of ro e
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: eril) REAGE: P P rty
<br /> Et it=c8ER og10-a- -1ab,t-o g—1 frontage drawn t cale.
<br /> TOWNSHIP:n SE c�I�r�
<br /> (k€ 1/4. N ,/,/. ,Sr ❑ ivew permits
<br /> st ,county,town
<br /> ADDRESS: n `r town)
<br /> i i CDui go ! Su,„ ��6,` t i 5357x• S,nitary permits 0
<br /> CSM: LOT SUBDIVISI N BLOCK/LOT
<br /> o2 l +, k\t se fa •ublic,private) J
<br /> PROPOSED PROJECT INFORMATION, 'r
<br /> PROJECT DESCRIPTION:
<br /> I � �'
<br /> V K •I. • • aCLCt' 1- d A. "4' 4*®-' a?i P C < E
<br /> ❑This project is a new building or structure. s a '�
<br /> tar 'S F
<br /> .This project is an addition/alteration to an existing building or structure. - '
<br /> SANITARY SERVICE: PERMIT NUMBER: --4����114r,i',i,�,",""Y.zi--.
<br /> 1
<br /> El SEWER SEPTIC T�� �, ` "
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) "'x .: -§
<br /> AREA TO NEAREST SQUARE FOOT: F
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r �i
<br /> BASEMENT: 1ST FLOOR: a ,t e ®� �
<br /> �� C S�69 4, TOTAL SQUARE FOOTAGE: ,, ,"° �' -- 4
<br /> 2ND FLOOR: 3RD FLOOR: lid °' ,, Z
<br /> ESTIMATED CONSTRUCTION COST V:rM04ij-4Pt -4124 g i
<br /> % � 8®t9ecw�',
<br /> (Please round to nearest dollar) � '�'�' •� � "* '� $ 1 (c)� (9 00 ���� � q,����� � ; - `-"`-
<br /> 1 Y C `ur
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,i No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Q 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 2'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 —BNo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► -10
<br /> 545.112(4/08)
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