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.SUPPLEMENT-toWeb•App#-
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER.INFORMATION .. z= , ,, " ,; ;�-�:� -.=,_. ., t,-:-: CUSTOMER TO PROVIDE
<br /> OWNER NAME � )'
<br /> 1,1 S Gt q- /C e h Ie'1‘r-- .
<br /> 0 Zoning Statu • ,
<br /> OWNER ADDRESS (Number,Street tapZi )p Vie/ Deed rlction;CSM
<br /> 4 7p 7 V r l #.11 S w V ' nce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 3sy/& D Sit Plan drawn to scale
<br /> AGENT INFORMATION -: CONTRACTOR INFORMATION a d includes dimensions
<br /> AGENT NAME CO TRACTOi:)ei_AME /
<br /> Same Cf! �s,�ae F O r Ck e e C_onr £L, it Plan including location
<br /> AGENT ADDRESS CONO�CTORADDI ESS a well/septic
<br /> O6h h t '
<br /> (City,State,Zip) (city,Scat ,Zip �t Setbacks
<br /> Zip), w S� s7�
<br /> PHONE PHONE ❑ Si Pla proval from
<br /> GOBS '/?9—3--Bo pl. ble township.
<br /> E-MAIL ADDRESS E •ILADDR SS
<br /> / Floor plans to scale
<br /> 4) ucch eh o t'�r., 47 ' ,, . eOM.
<br /> PROPERTY/LOCATION-INFORMATION'.:(httpJ/Iccessdane co:dane.wi.usn? Li Elevation of
<br /> property
<br /> rty PARENT PARCEL NUMBER: CURRENT NING( ACREAGE:
<br /> ❑ PARCEL 0 6 n ( . 1 ©L ,Ve 0 '-P ER
<br /> 14,, ? frontage drawn to scale.
<br /> TOWNSHIP: / SECTI N: (�
<br /> Si)E S kt dlH l e 10 ,�:S 1=- 1/%. N ❑ Driveway permits
<br /> (state,county,town)
<br /> AD RESS: Li a ,i 7g7 Grl ❑ Sanitary permits
<br /> CSM: LOT )) SUBDIVISION BLOCK/LOT
<br /> 6,-t eS 9Y3 0 Pr r� LQ4' (public,private)
<br /> —
<br /> PROPOSED PROJECT INFORMATION:;!r : :' :LTA .
<br /> ::'
<br /> PROJECT DESCR'TION: / r �;��� � }� � . ,.
<br /> 0 . 1 ni 41,E
<br /> ❑ his project is a new building or structure. - ,"' 7>=
<br /> 0 This project is an addition/alteration to an existing building or structure. 3z a' ri
<br /> SANITARY SERVICE: PERMIT NUMBER: 41.°8914
<br /> ❑SEWER SEPTIC
<br /> ��, � gaff a=
<br /> HEIGHT IN FEET NUMBER OF STORI S: (Not including basement)
<br /> m t o 3°1,E*Atil:
<br /> 1`,.:-=,-.1 AREA TO NEAREST SQUARE FOOT: -
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) w (f� �:.
<br /> BASEMENT: 1ST FLOOR: k : -
<br /> I 4, TOTAL SQUARE FOOTAGE: 4, 1 s �C i. ,, � „`
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: G3� oiO :' ® .a o,e
<br /> (Please round to nearest dollar) -► -i -► -► $ /0/ / o, .� cps.,, , "
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes C • Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IN o .Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? '►=Yes 0 o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes W N' o
<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) Li Yes No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes to
<br /> 4Q, t,i, APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -► -►
<br /> 545-112(4/08)
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