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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY-OWNER.INFORMATION =_ ' �, -X1, ,,,` `, f,=.' `.-- CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) ` / , �-c,� Deed Restriction;CSM
<br /> s-2_e 3 N- �;\-e_ �-& . �!t_v-ov\,ck , �,1J .S 13 Variance(# )
<br /> HOME PHONE (51,08_.) CELL PHONE E-MAIL ADDRESS
<br /> `e 9S. 5-04.9 HIS.210• I E3 bi- v'Jb v,0.na.ec P© a1.a:o•Co
<br /> ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and• and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ? 10 \I gha,e,, - I\vwo5 a-- fk t LI Site Plan including location
<br /> AGENT ADDRESI CONTRACTOR ADDRESS of well/septic
<br /> 6283 Ki. -12-;te,.i j 9e 04'19- 3 11 s L HN
<br /> . \--+ 1 L}
<br /> (City,State,Zip) (City,State,Zip) LI Setbacks
<br /> V era l W m\f. �� ' V\rl
<br /> �- I c00- �-:c_�. cv, ev e d I
<br /> PHONE PHONE LI Site Plan approval from
<br /> 9 LS- 2-10• 186 Co t- (o O8• 5-3c, . 349 8 applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> v-‘)\=> ■4,a- %-e12-al oLLVD, a , Ni►°c ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION+::(http:l/accessdane.co dane.wi.asl) • ❑ Elevation of ro e
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rtY
<br /> ❑ PARCEL 0604• -02.1-8551 - frontage drawn to scale.
<br /> NUMBER � �S et.
<br /> TOWNSHIP: SECTION:
<br /> S. .r;^—CS A e_ ,/; ,/,/• ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> CSM: `SAS �S LOT ❑ Sanitary permits
<br /> SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION; ,. i A -
<br /> PROJECT DESCRIPTION: +' 8
<br /> ..1....._ s �� '�.e& — w r-:- vrwn ) S �D-
<br /> This project is a new building or structure. .
<br /> ❑This project is an addition/alteration to an existing building or structure. .±..P -, r -�
<br /> t, `a it SANITARY SERVICE: PERMIT NUMBER: „ ,g
<br /> j
<br /> ❑SEWER ❑SEPTIC �
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - f .r, :' -1
<br /> 5-
<br /> AREA TO NEAREST SQUARE FOOT: ;
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) " ." '- : - £�
<br /> BASEMENT: 1ST FLOOR: <, e!�'t r�
<br /> t 9 .1,...--L u z ,I, TOTAL SQUARE FOOTAGE: ,l 4 . . ? R,I�tt: t, �b
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION ...4. _4. I L) (J � a,, ® ,{ ,,.(Pleae round to nearest ♦ / V :
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? -1Z 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? ,fYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes fflNo
<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 grNo
<br /> leAPPLICATION MUST BE SIGNED
<br /> 545-112(4/08) 5'0 (Continue on Back) -► -► -►
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