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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 /> CAa7 AUE L_LZ ❑ Zoning S ;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) De estriction;CSM
<br /> I+a')3 SLHNEt b EQ ` 0 ba ,,.,,..S 5'3S-7 S lance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> •• • `636'°c88<0 CAA #38-6-88(o S'te Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 25 t&_. ccios-i-Q.uc..)o,-) ‘..t-c__ ,�-s:r_(L C_,..„s-, LL.L ite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic
<br /> 1-14 S8 A)L_L_ =-b L/4 N IL-t_ e?D .
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> .)Q-Cvo,) , %..3.5 5'S43-76 C72CGO1--) )L4 i-S 53575
<br /> PHONE PHONE ❑ Site Plana val from
<br /> GO`i `1335- . 54_,-t 60,6 3S� -a Sa-� a e township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> -r.„.„..,e ra, ,,c.c�,,,_ coNst,,,,k,aw co rn 't"oM c, b r51_er c.„5t,r,er,0.,4 ,co:,1 ❑ loor ns to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation PARENT PARCEL NUMBER: CURRENT ZONING: on o property
<br /> ACREAGE: P P rty
<br /> NUMBER MBER COCo 10& (S9 cD� RN-1 'j( �. frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> 'p N N as\ 1/4: t.3\- 1/41A: N ❑ Driveway.p6rnits
<br /> ADDRESS: (St county,town)
<br /> 43-9.3 5C-aJ N E t 0 EQ oQ-tc.,47,., , u'S 5 35?5 ❑ Sanitary•- its
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> i 5-7 °1 / (p • • ,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESCRIPTION: I
<br /> • ❑This project is a new building or structure. ' ::
<br /> 13 This project is an additio Iteration to an existing building or structure.
<br /> V'j SANITARY SERVICE: PERMIT NUMBER: 'a 1 . ��
<br /> ❑SEWER SEPTIC tg ,-
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' _
<br /> AREA TO NEAREST SQUARE FOOT: ' � � �j" '`�fali
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) `;, 44 ,,"
<br /> BASEMENT: 1ST FLOOR: $ s P1
<br /> �, TOTAL SQUARE FOOTAGE: ,� , •' '1 t
<br /> 2ND FLOOR: 3RD FLOOR: ,
<br /> ,
<br /> ESTIMATED CONSTRUCTION COST: -4 ♦ --► ♦ ♦ ♦ 4,� c •,g#
<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 JNo ❑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? ❑Yes ®No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? a 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) DYes Et No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> ......# l�
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ♦ ■ -►
<br /> 545-112(4/09)
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