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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNS NAME g ili
<br /> arl e / Z /% Zoning Status;CUP; / V
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> -266 3 it--/we/73 Marsha l C,.); 5355/ Variance(# )
<br /> HOME PHONE C L PHONE E-MAIL ADDRESS
<br /> 9aO-3.SO-.24ti 6 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ,14 Site Plan including location
<br /> AGENT ADDRESS j�}� CONTRACTOR ADDRESS of well/septic /
<br /> (City,State,Zip) 5 q ' " ' (City,State,Zip) �P Setbacks SO /�/�/
<br /> PHONE PHONE OA Site Plan approval from
<br /> applicable township: it
<br /> E-MAIL ADDRESS E-MAIL ADDRESS �
<br /> 01 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:laccessdane.co.dane.wi.us/) A
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 01-
<br /> 1 Elevation of property
<br /> ❑ PARCEL (p� frontage drawn to scale.
<br /> NUMBER Y o�/�–oyl—g'/3o-o R ,L/ ._/ �./J`�
<br /> TOWNSHIP: SECT/'. �
<br /> 0( l< 1/4: 1/41/4: kr P Dr way permits
<br /> to,county,town)
<br /> ADDRESS: 3 IVIS
<br /> /3 s 4_,,,,,,k..., w 23 Sanitary•- ••'s
<br /> �CSM. LOT SUBDION BLOCK/LOT (publi. •
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPT ON: r
<br /> °e s : e f,' / co'1 e l/✓ Fri-S�C - Q I D -. • $
<br /> . 4 This project is a new building or structure. ;:'
<br /> LI This project is an addition/alteration to an existing building or structure. r7 F
<br /> SANITARY SERVICE: PERMIT NUMBER: :'y''� ; °9 ,.-..,,, ,,,,,:,•,,,,
<br /> ❑SEWER ""t SEPTIC /;/ -44 �a3�. s :
<br /> HEIGHT IN FEET: -7 NUMBER OF STORIES: (Not including basement) . 3 t'-
<br /> AREA TO NEAREST SQUARE FOOT: _ v
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , ;i' � , '
<br /> BASEMENT: 1ST FL nnR• a • ® • V.i a —-- --
<br /> /660 6 81/ ,, TOTAL SQUARE FOOTAGE: 1 I •= f'Ig• , f,t om /P
<br /> 2ND FLOOR: 3RD FLOUR.
<br /> 4/3 yy E�.:.
<br /> ESTIMATED CONSTRUCTION COST: , - •• /�
<br /> (Please round to nearest dollar) —' "'0' —• $ /V pi 00 0.,�,�- F:4,d °
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes U.INo LI Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Li Yes ®,No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? &Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes allo
<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 17.4No LI Don't know
<br /> 7. Is this to correct a violation? ❑Yes E§.No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -♦ —► —►
<br /> 545-112(4/08)
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