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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER.INFORMATION°,.; •- z. r_' -, :; 0.7-;C :===',==,-.J'''.--',-;•11-1'-:".:
<br /> CU'TOMER TO PROVIDE
<br /> OWNER NAME
<br /> So t/C", •" f t ' '-' . f+t IA- cAk. ► 11 Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State ip) D ed Restriction;CSM
<br /> (,./ ) S)�t-3-
<br /> HOME PHONE C CELL PHONE E-MAIL AD ESS
<br /> i t' 3�l 'te Plan drawn to scale
<br /> AGENT INFORMATION>;;: CONTRACTOR INFORMATION: ;'._;,;,: nd includes dimensions
<br /> AGENT NAME ,, C TRACTOR NAME
<br /> LTIC-1- -tx...4, S' a Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic
<br /> kk l W, ik c. .0v(c-4 c*,
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> c IN,it Jt41,LL.JlJ1 j85
<br /> PHONE PHONE ❑ Site Plan ap al from
<br /> (0 U 8-3- ,CD- 3-1" pplic ownship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> �0 C"y►np.ult ci S 6C &'a' - •''ti loor plans to scale
<br /> PROPERTY/LOCATION:INFORMATION ::(http:Ilaccessdane.co.dane.wi.usn, .
<br /> Elevation of
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property
<br /> ❑ NPARCEL MBER 09- 1115/ 8 S0160 .,A" -3 '3 frontage drawn to scale.
<br /> U
<br /> TOWNSHIP: SECTION:
<br /> CO u Gr'Jvv I j ,/: N g W : S w ❑ Dri ay permits
<br /> ADDRESS:
<br /> state,county,town)
<br /> Z Z,3 - ip n r - ❑ Sanitary mits
<br /> CSM: LOT V SUBDIVISION BLOCK/LOT (pU ,private)
<br /> PROPOSED PROJECT INFORMATION. ",
<br /> PROJECT DESCRIPTION: A 2":-', , x�
<br /> ❑T is project is a new building or structure. 6r °_1 +-,
<br /> -TA This project is an additio alteration to an existing building or structure. -, `�
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> I� ��
<br /> ❑SEWER EPTIC ,t4 "!�s. a qiiig;
<br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) Ltrb'-: • _ �?
<br /> f , , at ex 01 F :
<br /> AREA TO NEAREST SQUARE FOOT: g
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,-
<br /> BASEMENT 1ST FLOOR: � -�r� ^^�- ����`
<br /> 3(„g 4, TOTAL SQUARE FOOTAGE: 1 �9 ti~` �"':°a' 4'
<br /> bb--UU ;"T-14 rn e ) 1
<br /> 2ND FLOOR: 3RD ,i--'.'61,44,,,, ,--r--:-.. .i.ik4,441
<br /> ;
<br /> ESTIMATED CONSTRUCTION COST: - i=* , ®t p
<br /> (Please round to nearest dollar) "� "� Z.l VJ J '
<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? es ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes .0'rlo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank f none)
<br /> 6. Is a location survey required? (see reverse) DYes No ar
<br /> 7. Is this to correct a violation? ❑Yes o
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
<br /> (Continue on Back) —► -* —0.
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