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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
<br /> PROPERTY.OWNER:INFORMATION z; ._ _ 4, 3.4R;=, -: /� .-'< f;::-J1-::::--, :-4 CUSTOMER TO PROVIDE
<br /> OWNER NAME 'N • Q_S'e.' • V
<br /> 6i---
<br /> "' ',-7k)V�i.-i6 , '' , y, . ;■ ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street City,State,Zip) Al/GI" '-`, (,(f/ Deed Restriction;CSM
<br /> 94-01 (i' 251°x ,/,) c9x&e-- 40540 322 —
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> IA/-"'3‘015-6 a9 - Site Plan drawn to scale
<br /> AGENT INFORMATION,;;: CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> /C'A' / kV /*L-7 i9.9Gh/i ,//l/ ZeitJf7,1/r7DN. ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> B /J¢ /°f/!/Lft'JJ I € "J /ZD/ f JT46•'oAv / 42j
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> \ i4, // 53597 MAa/joiv u// 53709-
<br /> PHONE PHONE s 0 ❑ Site Plan approval from
<br /> ,pOQ' e4-5-1,58/ ‘,815 - 222. - ,,e,6 9 applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> r. he Gr• aldd a4z ./9P pp Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION:;(http:l/accessdane.co.dane.wi.usn: ❑ Elevation of property
<br /> PARENT PARRC�NUMBER: CURRENT ZONING: ACREAGE: P P rtY
<br /> ❑ NUMBER D37 7a / "353 7335'd �v. o 76 frontage drawn to scale.
<br /> TOWNSHIP: SECTION: ❑ DfIVeWa permits
<br /> TRESS G, A//�90%/0x/ 3Y '/<: S.vu 1/41/: S�'i (state,county,town)
<br /> ADDRESS:
<br /> 2q0/ / t ' fT ❑ Sanitary permits
<br /> CSM:
<br /> 0 05 ¢(p LOT SUBDIVISION BLOCK/LOT
<br /> oT (public,private)
<br /> 3
<br /> PROPOSED PROJECT INFORMATION,!:! : r '°""
<br /> PROJECT DESCRIPTION: ",.: ��
<br /> �. to � , ter, r < �
<br /> it) E vi2-- LT5frA /04) iiys
<br /> ❑This project is a new building or structure. ; {sp{$y x�-
<br /> This project is an addition/alteration to an existing building or structure. ; ,-, k-
<br /> SANITARY SERVICE: - �---' z.
<br /> PERMIT NUMBER: ,,,,--6.7:-.,:4:4.-_%_3 rt
<br /> Z EWER ❑SEPTIC '��� �v, ', .s- .
<br /> ,-
<br /> HEIGHT IN EET i � � NUMBER OF STORIES. (Not including basement) � '-'� '��,t� ` , ;' �-t
<br /> t � S
<br /> AREA TO NEAREST SQUARE FOOT: �
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , ti °4 �,
<br /> BASEMENT: 1ST FLOOR: e e r '
<br /> C� c o 0 4, TOTAL SQUARE FOOTAGE: r -o.43 ��' `
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 429,040° 1J �� �
<br /> Ifs
<br /> ESTIMATED CONSTRUCTION COST: _
<br /> (Please round to nearest dollar) ♦ ".I. '♦ ♦ '♦ "♦ $ 2' �� �t° e ia�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes M o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ' ,, • ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? .' es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes k .
<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 O. ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ►4 .
<br /> 1V-Nck L_ 1-erM'tv._ a(
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -9 -► -►
<br /> 545-112(4/08)
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