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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION ;x +,h� ,
<br /> OWNER N• E CUSTOMER TO PROVIDE
<br /> OW ER ADD R SS (Num. ,St -et,City,St ) �� Zoning Status;CUP;
<br /> Fg 1 /di �U .4 , � Deed Restriction;CSM
<br /> HOM PHONE CELL HONE E-MAIL ADDRESS
<br /> Variance(# )
<br /> 60. 53�� VVV
<br /> AGENT INFORMATION /L Site Plan drawn to scale
<br /> ;;S:A/D-Na CONTRACTOR INFORMATION and includes dimensions
<br /> /��aYQ CONTRACTOR ME
<br /> s 71 u�<- p a '�i Site Plan including location
<br /> �l CONTRACTO f ADDR S/ g On
<br /> 5' S 7 81,0/7- of well/septic
<br /> (City.State,Zip) // �I As �� J�l�[J �j
<br /> State,
<br /> �� (City,state.Zip) / 11 Setbacks
<br /> PHO E j �� /flax)axs-
<br /> / U PHONE , d* Site Plan approval from
<br /> o,4-5 75 7/v e° Ze2) — �� c/`j applicable township.
<br /> from/
<br /> E-MAIL ADDRESS
<br /> J pp p:
<br /> E-MAIL ADDRESS
<br /> #:4 Floor plans to scale l
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> k ARENT P•- L NUMBS : CURRENTZONING: ACREAGE: / Elevation of property /
<br /> ARCEL
<br /> /f,_3 //_ 7
<br /> UMBER D!!!! Z i� j�—//� frontage drawn to seal /SHIP:
<br /> ADDRESS�un l /GZ/P/1� SE J �A: 51- ��%. A/ 11141 Driveway perm' � 4�
<br /> ��i� ^ _/� / (state,county, ' W/ ' , I
<br /> `l I (J` G fN /'7�
<br /> LOT SUBDIVISION BLOCK/LOT P:1 Sanita. ,
<br /> (publi a `!P
<br /> PROPOSED PROJECT INFORMATION
<br /> (J 1 a PROJECT DESCRIPTION:a 4 �c(o ole-y �� rQ ( cr �d� b
<br /> '
<br /> • his project is a new building or structure. � �
<br /> ❑This project is an addition/alteration to an existing building or structure. 7- y.) r i.-, 4- I
<br /> SANITARY SERVICE: PERMIT NUMBER: 4�
<br /> s�°� i "'E e s11s'Y "
<br /> ❑SEWER SEPTIC :'6' j""u$y Y .
<br /> HEIGHT IN FEET 5 0 ,
<br /> NUMBER OF STORIES: (Not including basement) y f
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,„.1 f;,-:_, ,,,..2.:, : ,,,,,_„._« //0
<br /> BASEMENT 1ST FLOOR:6 2 jvr� ® €m � (� Sr
<br /> if 4, TOTAL SQUARE FOOTAGE: 4 y 'pis q` .,` as
<br /> 2ND FLOOR: 3RD FLOOR: Lj
<br /> � Z 'IrI mot,
<br /> 3 A
<br /> ESTIMATED CONSTRUCTION COST: fit' s o:;,.-A {fit
<br /> (Please round to nearest dollar) $/ �oe
<br /> ♦ ♦ ♦
<br /> ♦ ♦ ♦ -� 1 t-g b4 :5a ami �
<br /> J � "+h,,a�S',,,, a*,mow; ;_. ,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes :�
<br /> 2. Is there a wetland or floodplain on or near the property? ,_ No ❑Don't know lekl,_
<br /> ❑Yes t.� No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes i1 No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'es ❑No 2-00 3 t 1 22
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# �/^'
<br /> 6. Is a location survey required? (see reverse) ) (leave blank if none) SI�,/�
<br /> ❑Yes vNo 0 Don't know
<br /> 7. Is this to correct a violation? 5/fi o,/1)V
<br /> ❑Yes No l
<br /> 9,2/ 00 APPLICATION MUST BE SIGNED
<br /> 545-112 ia/oel (Continue on Back) —0. -1.
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