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, s's-71-
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME q %
<br /> b L. 4 6 k 1.1 lit„)\L.C D 1■I
<br /> ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) L. % Deed Restriction;CSM
<br /> ��• HOME HONE CELL PHONE
<br /> Variance(# )
<br /> p'''11 1 E-MAILADDRESS ,,��/�
<br /> Ass-/7 Q V G)6e Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME �- �,/
<br /> 54-w-.2 tjjl"6- C 9-,..4 ' -•• J�l! Site Plan including location
<br /> AGENT ADDRESS ••NTRACTOR ADDRESS ,,( of well/septic
<br /> G.
<br /> 12o . cco rr s o}1 a / 2
<br /> (City,State,Zip) (City,State,Zip) 4 Setbacks
<br /> �// 'Y 4* foh► (</.' '3203
<br /> PHONE PHONE W Site Plan approval from
<br /> 6 o$• V CL/F 2-d applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ifkii--,41 •k 1,,,:.66 ,44-it Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property
<br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: (, y _ p p rtY
<br /> ❑ PARCEL 6��_ _ j 6 3 a,?. /' frontage drawn to scale.
<br /> NUMBER a•3-)-e - • /
<br /> TOWNSHIP: SECTION:
<br /> 3 A I u(, 6 A c,E I/a: ,S W %'/<: Ai h/ Driveway permits
<br /> AD (state,county,town)
<br /> 3 0 4 0 Uts I4 0,,up-0,
<br /> c LOT suBDlVls oN BLOCK/LOT
<br /> permits
<br /> �_ n' - ON to_.d_ ., -- (public,private)
<br /> PROPOSED PROJECT INFORMATION ��''� 7
<br /> PROJECT DESCRIPTI Sr, , <
<br /> �1Ai1 ,.: ryasgc-1, {..;-.. 'T'his project is a new building or structure. ,-,,,,,....,:-.,;=-,;,1
<br /> ❑This project is an addition/alteration to an - '- ' • • sing or structure. , rw
<br /> y�
<br /> SANITARY SERVICE: PERMIT NUMBER: ° s ° �•'( s
<br /> ❑SEWER EPTIC di - x�
<br /> HEIGHT IN FEET: ,NUMBER OF STORIES: (No including basement)
<br /> AREA TO NEAREST SQUARE FOOT: ?� � 1"
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) .g ,11,,,... 1
<br /> BASEMENT: 1ST FLOOR: 1 c2
<br /> �7V n Q 4' TOTAL SQUARE FOOTAGE: ,,, • .,�4 `' ,
<br /> !,V ..
<br /> 2ND FLOOR: 3RD FLOOR: �� ', ''- �
<br /> /93c ' �
<br /> ..mss ,= 1s�� f �
<br /> ESTIMATED CONSTRUCTION COST: . - r _. e a
<br /> (Please round to nearest dollar) "'0 ""0 —0 —0 "•0 '•'0 $ Q Q O0 r ��
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Ago ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes -No ❑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 Llo
<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 ICI fn ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes �1 Imo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ♦ —► —►
<br /> 545-112(4/08)
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