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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
<br /> PROPERTY.OWNER;:INFORMATION i f,;;- _ __ -', -t �,�,�.1,;.>: , .-:° ,c :1- CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> .I� £'-+ rL� Zoning Status;CUP;
<br /> OWNER ADDRESS (Numb ,S eet,City,State,Zip)
<br /> a HO 3 -1--1 . (r-os-S 477.D V �ct c^» eed R estn ctll s /
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<br /> HOME PHONE CELL PHONE E- ADDRES S
<br /> 4 a-(41' ' O=A Site Plan drawn to scale
<br /> AGENT INFORMATION , CONTRACTOR:INFORMATION ;" ,;„; and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME �� 1�
<br /> Site Plan including locatioon�
<br /> AGENT ADDRESS CONTRACTOR ADDRESS 1 r of well/septic
<br /> (City,State,Zip) (City,State,Zip) ''i Setbacks 63/3,/40iii
<br /> PHONE PHONE . 11:1 Site Plan approval from�I
<br /> .pplicable township. /'/ f
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> !v' Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION '.:(http:l/accessdane.co dane.wi.usl)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: /�� Elevation of property
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<br /> NUMBER � P14-1 - _ 2_,G
<br /> rontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> e tl 0 r- °L 1 I/: 5 A 1/4%: j 0.v gDriveway permit `A
<br /> ADDRESS: ■ (state,county •
<br /> dtO9-- ( L) 4e £r s / usolvlslo o BLOCK/LOT
<br /> ( gcSanitary p- ••is
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<br /> [j 3 (public, P A//1-
<br /> PROPOSED PROJECT INFORMATION. �_.,. A - ;. A''''7,7-,.
<br /> PROJECT DESCRIPTION: r�
<br /> X 2 i X /7 ' A ?”- r e 5 E 4 w
<br /> ��.3d Li�A &�.�c�'9 5-f
<br /> ❑This project is a new buildi • or structure.
<br /> This project is an -+••i i tera to o an existing building or str cture.
<br /> SANITARY SERVICE: :arm , e area-` ti 1I
<br /> PERMIT NUMBER: / i ,.,a, � ti��`�',1.?. �, ,,;, ,�
<br /> ❑SEWER brSEPTIC �r- � #+
<br /> a �
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<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) f < = , k f
<br /> AREA TO NEAREST SQUARE FOOT.
<br /> " �
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) + ,' i,'�,f ° ;
<br /> ae •� .x er wr
<br /> BASEMENT: 1ST FLOOR: ^ `
<br /> /J 4, TOTAL SQUARE FOOTAGE: 4, .. ��� tit° � �� 1
<br /> "".. 4 � <_
<br /> 2ND FLOOR: 3RD FLOOR: `� ^ " �r 5-y
<br /> 4.-,411,k-AiA--yq gr,OiT);;',."°'-t; g1-'' 4
<br /> ESTIMATED CONSTRUCTION COST: -► -► -+ -► $ 9� �� : V,ir;
<br /> Please round to nearest dollarr<
<br /> 1
<br /> 1. The property is within 300 feet of a stream 1000 fe om a pond or lake? Al Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tISNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No �C/�
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No 1
<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 ❑No
<br /> $ FYtc °
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
<br /> (Continue on Back) -4. -0. —►
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