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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME yy��,,,, /
<br /> K '„obel& R i//un, to Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 'I117S Rick°rz l Run) (,WPtlitNAPe€. l.t .53 5?? Variance(# )
<br /> HOME PHONE CEEAL PHONE E-MAIL ADDRESS
<br /> 6ce-83& -sV70 rjl a-al,50 10: Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> fob -1- A- jA j,i 2 ite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS 4tf well/septic
<br /> 7175 N I c/t,urt,s! 1ZVA. .
<br /> (City,State,Zip) (City,State,Zip) JJ g :etb ks
<br /> U,A)A-t&., L-C)t 53 547
<br /> PHONE PHONE 1. ite Plan approval from
<br /> �2 6 147 712-23 50 .pplicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> M Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL NUMB R: CURRENT ZONING: ACREAGE:
<br /> ❑ NUMBER na ag )etc 8 3 0 R- ) a . e �Y frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> S Q I1 I J F,.e.I d .1/4: ,/4,/: Xi Drive permits
<br /> s e,county,
<br /> ADDRESS: co town)
<br /> '7175 1-Etc,k0n. T20 Ni tOAuA2Ak.ea, Wl 52 S`/7 Sanitary rmits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 1 3 Hickoh.y lltgl &L publ' ,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJEC DESCRIPTION: Ate:
<br /> • ❑This ,,roject is a new building or structure. )c tJL ,,
<br /> ' ear , 'f n7 :
<br /> This project is an addition/alteration to an existing building or structure J •.A r Al , F- � , ,�
<br /> SANITARY SERVICE: PERMIT NUMBER: . , •a
<br /> ❑SEWER SEPTIC k' '', .^ S„
<br /> HEIGHT IN FEET , NUMBER OF STORIES: (Not including basement)
<br /> AREA TO NEAREST SQUARE FOOT: ® * - u �ry
<br /> --Ayxj.,e", ---- -(Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR: a ® $ , b
<br /> 6
<br /> ' 4, TOTAL SQUARE FOOTAGE: 3 „�' ,,��'
<br /> 2ND FLOOR: 3RD FLOOR: ∎� �j/�/ � ��
<br /> Zoordinin co_A ritz,„441#021,01;,:p?tiFF-litiVrIVi'
<br /> ESTIMATED CONSTRUCTION COST: fj� r ,��
<br /> (Please round to nearest dollar) ♦ ♦ "♦ '♦ "�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fkiNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 12(No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 4No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes VNo
<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 1'No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes .gNo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) -i —►
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