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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION` CUSTOMER TO PROVIDE
<br /> OWNER NAME /
<br /> C'
<br /> �rel1i >'/q/c' o,dl S i�e'e r- ©0 6 SO h ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> .S"gv a Plo e'ero /a,-,a 11 Deed Restriction;CSM
<br /> a r��// �// Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6412-.. 0,'- -7iCa ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ' C A/if 67‘),/{ ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 7// Chi,,,didh ,T r
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> r )te,a//✓,, G, / S-17/
<br /> PHONE PHONE / ❑ Site Plan approval from
<br /> 6 ci 8 A?p-S-- '9 9 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> CAi%s / ret//o4/0 ef,e(/v,..' ❑ 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 / frontage drawn to scale.
<br /> NUMBER ag/%--/old/_ , S4/-d A' ` F X
<br /> TOWNSHIP: SECTION:
<br /> S vf-7 /'/'vi,,"/l D R /,D 1/a: ,5 E %I A: N E. ❑ Driveway permits
<br /> (state,county,town
<br /> ADDRESS: ( town)
<br /> s-S d Pro soeetor ,0 e-
<br /> 0 Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> 3`-V ©ro'-drr i.!50,40/ s 4elei,7:,.,
<br /> PROPOSED PROJECT INFORMATION -
<br /> PROJECT DESCRIPTION: : � � �
<br /> /-) fit, Cam.
<br /> . ❑This project is a new building or structure. c>.F 4 v re 4 �_ a -
<br /> ®1 his project is an addition/alteration to an existing building or structure. E:: , ;- ��
<br /> SANITARY SERVICE: PERMIT NUMBER: ‘tAtiAt' �„
<br /> ❑SEWER X SEPTIC 0'A' -°<, _ 7 --
<br /> ,ii
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) � �y-�
<br /> d feet -&e-,¢v
<br /> AREA TO NEAREST SQUARE FOOT: yrh
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' , 4 ''
<br /> BASEMENT: 1ST FLOOR: ��t r .. c
<br /> 4, TOTAL SQUARE FOOTAGE: 4, 4-I, aW
<br /> 2ND FLOOR: 3RD FLOOR: ��� �<
<br /> x s -,,
<br /> ESTIMATED CONSTRUCTION COST: . 4�
<br /> ♦ ♦ -► -∎ --► a4,, ® : t
<br /> (Please round to nearest dollar) .�Q�d
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ■o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Cgire-s ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? g-Yes ❑No
<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 ag-o ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> 7 Z APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ■ -► -►
<br /> 545-1 12(4/08) S w
<br /> Z ro
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