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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to.Web-App#
<br /> PROPERTY OWNER INFORMATION a.;; .-, 00.=' ;:: i_ ti CUSTOMER TO PROVIDE
<br /> OWN/ , R NAME r--j--� r
<br /> L( I (I�2 if( �2 ` rl�--4& ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS umber,Street,City, ,Zip) g '
<br /> 2' I �c;_� f - j /� Deed Restriction;CSM
<br /> 3`L ( C `�L erfr, 66� J 3c_5 Variance(# .S"f-C )
<br /> HOME PHONE C LL PHONE 02 ro E-MAILP(�7DRESS l
<br /> (90cc;4' a gt7. a Z a", +l i/ ♦ 4'Site Plan drawn to scale
<br /> AGENT INFORMATION „ CONTRACTOR;INFORMATION ;,- and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME /
<br /> AGENT ADDRESS U7 (ilc ` e_ a,Si P n including location
<br /> ;'" coyTlucTORDi ESS of septic
<br /> ,, `'J�,fl� ��` c(
<br /> 1
<br /> (City,Sta-, '. ' (a star ,Zip) ❑ Sett�ks JG>`!'�'c� _
<br /> 4, (C e 02fiGVU cc.)( S
<br /> PHONE PHONE 1, L4 Site Plan approval from
<br /> IR W — c3)--go' - applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ja 7 7-0 I I 6€ ,, c.,` Floor plans t• .le
<br /> PROPERTY/LOCATION`INFORMATION (http://accessdane.co.dane.wi,usl)!•, ,`` ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: f_./ i S CURRENT ZO ING: AC EA : P P rty
<br /> Li PARCEL i^n/o s/ra 02 y_ 7.__m_ ) _ rontage drawn to scale.
<br /> NUMBER KJ d-
<br /> TOWNSHIP: SECTION:
<br /> A-1-13;I 1 ,: S %-/: Drive y ermits
<br /> ADDRESS: �/� -Y/'(T-`i_ (state, nty,town)
<br /> — -- ►=i Sanit_. per its
<br /> CSM: LOT SUBDIVISION BLOCK/LOT •UbIIC, • ate)
<br /> PROPOSED PROJECT INFORMATION, �� ;
<br /> PROJECT DESCRIPTION: r - �r<s :i :1:
<br /> -ice,i� 7s��_.am—tf omi, O,� c1-1 i . .Q..f.�` ;,;:�- .PfO k :
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<br /> vThis project is a new building or structure. asp y
<br /> pis project is an addition/alteration to an existing building or structure. - i
<br /> SANITARY SERVICE: PERMI UMB R: i'. 'd:-'41)1 `,f
<br /> ❑SEWER ! SEPTIC °'-: -- < «
<br /> HEIGHT I, - NUMBER OF 'ORIES: (Not including basement)
<br /> l6a.1ssi#EI:4
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -- ® i ,
<br /> BASEMENT: 1ST FLOOR: - �y s1
<br /> ,�, TOTAL SQUARE FOOTAGE: i, a �.,��`�'g�,F°ot` ,�ia�Ea ,'4,--: h �
<br /> 5
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> I _ ,,
<br /> ESTIMATED CONSTRUCTION COST:
<br /> —► ♦ ♦ ♦ ♦ ♦ 1.611 a v l� i:z-
<br /> (Please round to nearest dollar) ) O ��,,,� �; -�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes -No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El.No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? W,Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? giYes ❑No
<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 i Don't know
<br /> 7. Is this to correct a violation? ❑Yes Flo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -* -► —►
<br /> 545-112(4/08)
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