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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OW ER NAME
<br /> 4- A 4. I,
<br /> OWNER ADDRE (Number,Street, ity,State,zip) �O ID Zoning Status;CUP;
<br /> O �� Deed Restriction;CSM
<br /> .�)Q Variance(# )
<br /> HOME PHONED CELL PHONE $ 0 E-MAIL ADDRESS
<br /> d �z S _' m///S •r✓�/s fd -56C'//Q ,1, --/-0 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> , 4. 5 /Lf/L T ❑ Site Plan including location
<br /> AGENT ADDRESS CONTggCTOR ADD.qss of well/septic 81 dIA)
<br /> (City,State,Zip) (Ci Lr[rate,Zip) ❑ Setbacks
<br /> PHONE HON / - - L 5353 ❑ Site Plan approval from
<br /> 2J%ZJ'9-f307 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL �_ DO�Z 5 /2.3
<br /> frontage drawn to scale.
<br /> NUMBER 05C,2
<br /> TOWNSHIP: , SECTION::" �/
<br /> dco, 1/i: /✓e- 1/.1/: ,,v ❑ Drivew permits '`
<br /> AD//DRESS: (sta ,county,town)
<br /> CSM LOT 1 SUB, BLOCK/LOT ❑ Sani permits Q(
<br /> u cc,private) ,,1
<br /> (PPn P ) 1"
<br /> PROPOSED PROJECT INFORMATION '-s
<br /> , ';.=-' $r :7704/ . -`PROJECT DESCRIPTION: I .,::., ,,:,1,74.,t,
<br /> ❑This project is a new building or structure.
<br /> ekt f'This project is an addition/alteration to an existing building or structure. t ��
<br /> SANITARY SERVIIC PERMIT NUMBER: 04. st a .4d
<br /> L7 SEWER ❑SEPTIC . ff t
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) :, �
<br /> w i� '� S.
<br /> :n,
<br /> AREA TO NEAREST SQUARE FOOT: � _` 7 -:`? i.
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,,4,,‘
<br /> BASEMENT: 1ST FLOOR: , $ $ 'x
<br /> ,I, TOTAL SQUARE FOOTAGE: , ° ( € 4
<br /> 3 ® a� � rya
<br /> ;,
<br /> 2ND FLOOR: 3RD FLOOR: '��° , q
<br /> `a o- s e, s
<br /> ESTIMATED CONSTRUCTION COST: t ® _ q,, =., ;::
<br /> (Please round to nearest dollar) • —• "'∎ "+ $ )� 5)� 0, - ® X5 z�'
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? T I2Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? 12/es ❑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? LI Yes I iicro
<br /> Ols this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) W Yes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes EKo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► ■ —►
<br /> 545-112(4/08)
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