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09/25/2008 14:02 608-267-1540 DANE CO PLANNING PAGE 05/07
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<br /> ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App#
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> I C-h A r2 a Sv C j c.,2. ❑ Zoning Status:CUP;
<br /> OWNER ADDRESS (Numb?r,Street.City,Si .?de e Deed Restriction;CSM
<br /> /A 0 / W PS1-71 (A)5 re, DA-• variance(# )
<br /> HOME PHONE CELL PI-IONE E-MAL ADDRESS
<br /> t, 0.9 STS-.Gy '0 4,-.)0- 2'7-°0 7 TuP16102-ecoi•cAst. N- ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> miry,sab,ZIp) (CIty,Bone.?!p) ❑ Setbacks
<br /> PHONE PHONE ❑ Sits Plan approval from
<br /> applicable township.
<br /> E•MAH.ADDRESS E-MAILADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:/raceossdane.co.dann.wi.us) Q Elevation of property
<br /> PARENT PARCEL NUMBER CURRENT ZONING. ACRGAGC: frontage drawn to scale.
<br /> ❑_ P1�_ �512. 2'SN -Zt�� 3
<br /> TOWNSHIP. SECTION:
<br /> Iti.• Io+-t .2_ , y4. Se 1h14: NW 0 Driveway permits
<br /> (state,county,town)
<br /> ADDRESS:
<br /> 3/p 1..-cav-1. S■ ortE�tt.vE ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION�,`' BLOCK/LOT ' (public,Ovate)
<br /> PROPOSED PROJECT INFORMATION
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<br /> PROJECT DESCRIPTION; l'';', j? ;. 7 74)717 -�
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<br /> . ❑This project is a new building or structure. ,,I, -- , ('.
<br /> �r,� P J g ,3,ki i:,41:. , Jig ,�
<br /> This project is an addition/alteration to an existing building or structure. try, t -4�� , 't ; ,a }gIii
<br /> i 1 5 I ,I. ' +,i 1
<br /> SANITARY SERVICE. PERMIT NUMBER: , ''-'�`^Ij } '. 14,
<br /> FEWER EJ SEPTIC 2.nl'i;i;��d 'M '{ $%ii'k,.',' 4, ' '
<br /> HEIGHT N FEET. NUMBER OF STORIES: (Nal Induding basement) ' ' �,. ` "..',':111„e,'0,r I' )t
<br /> AREA TO NEAREST SQUARE FOOT: 1 4'ri � :( k`,1y1 'S,I'` 4r'
<br /> (Outside dimensions including unfinished area attached garages and above grade docks or porches) ; ;, c L,t (. ':',','4, r ,
<br /> BASEMENT. 1ST FLOOR:
<br /> 4 TOTAL SQUARE FOOTAGE 4 rt'I '., ray,-I„a ./1 ,,,,.;,,,,Irt
<br /> 2ND FLOOR: 3RD FLOOR i ; (I 1�'t,,,,,',.,
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<br /> ESTIMATED CONSTRUCTION COST: q;�I',C�'F ' '1� ,,ioo�h:%^'1;'IxI
<br /> (Please round to neatest dollar) ♦ -► ♦ -P -► -► ,,..:R 1`' `` ifi ,"..7,'',1.' -'.1".,-'I I:.'':.+??:
<br /> 1. The property Is within 300 feet of a stream or 1000 feet from a pond or lake? Yes 0 No U Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? 12.Wes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? XYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years?.. ❑Yes IgNo
<br /> 5. Is this project associated with a rezone/CUPNariance(petition/appeal# 8/f ) (leave blhnk if none)
<br /> 6. Is a location survey required? (see reverse) ' .Yes ❑No 0 Don't know
<br /> 7. is this to correct a violation? ❑Yes ANo C.' 1'7 ce,-?c .-E.
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) --► ■-■ -.
<br /> 50-112(AM)
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