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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION '� . s
<br /> OWN AME ";,;t - ,� . x `
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<br /> OWNE ADDRESS (Number,Street,City,S le,Zip) II l l .i £ ,a id
<br /> PHONE E-MAILADD ESS
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<br /> AGENT INFORMATION CONTRACTOR INFORMATION
<br /> AGENTNAME ,rE -
<br /> CONTRACTOR AME
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<br /> AGENT ADDRESS W 2cy_
<br /> CONTRACTOR ADDRESS '4
<br /> (City,Stat iP) ity,State,Zip) -: f $ a �_
<br /> PHONE �-, s
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<br /> PHON F�, 1 ,
<br /> E-MAIL ADDRESS
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<br /> E-MAILADDRESS � „�, ��,
<br /> AA 15-5 I PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wi.us/) 'p ,
<br /> PARENT PARCEL NU BER: �r ZONING:/ ACREAGE: , '
<br /> ❑ NUMBER 0_� ♦ r OJ `� Oa r 3 x q
<br /> x
<br /> -4 TOW HIP: —� - cy SECTION: ,
<br /> ADDRESS: "i
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<br /> CSM: LOT SUBDIVISION 2;14. 14_J BLOCK/LOT p � +
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<br /> PROPOSED PROJECT INFORMATION `.3
<br /> PROJECT DESCRIPTION: ,
<br /> J1 dL�IJ7Y� C7, ,..c._. eV U�l°`OL1 C ! I C 0Y1 ( , Q `
<br /> This project is a new building or structure. . E 3
<br /> ❑This project is an addition/alteration to an existing building or structure. $ t E
<br /> SANITARY SERVICE: PERMIT NUMBER: €�E '
<br /> r�,,EWER ❑SEPTIC a9 g
<br /> HEIGHT IN F
<br /> f
<br /> NUMBER OF STORIES: (Not including basement)
<br /> AREA TO NEAREST SQUARE FOOT: ;
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g
<br /> BASEMENT: 1STFLOOR
<br /> ��j r(r" 4, TOTAL SQUARE FOOTAGE:
<br /> 2ND FLOOR: �4 3RD FLOOR: 7 :1,
<br /> ESTIMATED CONSTRUCTION COST: u�� J ;,:,'„„t% fit
<br /> (Please round to nearest dollar) 0 a SU •
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't know
<br /> 2. There is a wetland or floodplain on or near the property? ❑yes
<br /> ❑Don't know
<br /> 3. Have you talked with the township about your project? ': Yes ❑No AY
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years?� ,No
<br /> 5. This project is associated with arezone/CUP/variance(petition/appeal# s ) (leave blank if none)
<br /> 6. Is a location survey required? v.. -'JU Yes ❑No �w
<br /> 7. Is this correcting a violation? Yes jNo
<br /> ` VANE COUII�TYF RAVING&Df
<br /> � y 1,' �ATION MUST BE SIGNED
<br /> 3 Y 77 (Continue on Back) —► -+ —►
<br /> sas-1121110B) • , .
<br /> 3ux.{5 ( 350 / D`
<br /> 34x, 1, •)4c
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