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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME ii
<br /> , t 44.4. �c it ,Q ic-h/li .3 ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS,,(Number,Street City,State,Kip,) Deed Restriction;CSM
<br /> '097 R, ,� pQ, DaQr4,e 1J1 .53 .3/ Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> kg-6,5c-/3 70
<br /> ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 4011.f1.4-1 610142-RvjdQ ns5
<br /> ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> S'74,Liner r.
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> Ste.-• Prek);7t_ t✓/ 537
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> C,0 8--YYq. 877,3 J7,'N applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ja.+&A diet/ ,iee-let.,®aei ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.usn
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL 6Ss/e$//-3ff1-$5'S'5-.-0 RI-p /, S' frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> i vn Prr,ci e_ 3(, '/<: .SF 1/a+/; / /,t,1 ❑ Driveway permits
<br /> . (state,county,town)
<br /> 1i 7 Ply._ Rin 1 Yv_rf iPdn A)) -5353/
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> lD (public,private)
<br /> sy�
<br /> PROPOSED PROJECT INFORMATION ', T �
<br /> PROJECT DESCRIPTION ' r s
<br /> Et This project is a new building or structure. k - d
<br /> ❑This project is an addition/alteration to an existing building or structure. 1-7.,,,,� � o
<br /> SANITARY SERVICE: a 1- e s 14-4_
<br /> h
<br /> ❑SEWER ❑SEPTIC Iiiiiiiiill.11.111U" + t a r ..-71":`,:::. ,„1:2i.)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> 45-'7" i ..2,Alk pit-,',
<br /> AREA TO NEAREST SQUARE FOOT: , der
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 -
<br /> BASEMENT 1ST FLOOR: � �� � ''',4,7,,,,,,,i1.,:::::,:,,,,,.4® r a �
<br /> d 62/ 4, TOTAL SQUARE FOOTAGE: 1 , I 317-.;11r,-
<br /> 2ND FLOOR: 3RD FLOOR:/ t g
<br /> ESTIMATED CONSTRUCTION COST: ,k
<br /> (Please round to nearest dollar) //1 5-eV. oc,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes AN No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? LI Yes 0 No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes El No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? &Yes ❑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 ❑Don't know
<br /> 7. Is this to correct a violation? CI Yes iiiNo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) —► ■ —►
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