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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 /> \�VVnh _ S, RC.4►'0t0r, ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Numbler,Street City,State,Zip) _\
<br /> ;.9.0 G `'0� e /v \ 1 I - C\ekv / - Variance Restriction;CSM )
<br /> HOME PHONE CEL NONE E-MAIL ADDRESS
<br /> 6C-13— b T ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> kIL\C.'8- Ott)4C" Ge- w,c, -; r\ ca,,,,`h,-vc_ ,,`.-,r,Ti v ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> -?(95- - e1s - (.r- 705 --c),,,-- Y0 te- iu,-\ .
<br /> (City,State,Zip) (City,State,Zip) LI Setbacks
<br /> -nt tT
<br /> 5-55-41 /la?�> �tv t W3 .S-Y---)� v
<br /> ❑'zc4 1M v /
<br /> PHONE PHONE Site Plan approval from
<br /> Coo - Zt5- —&c5/c, bc.( Z15 e )2 applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS `
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ PARCEL In_°�_g51a_S frontage drawn to scale.
<br /> NUMBER � /°'�� (
<br /> TOWNSHIP: SECTION:
<br /> '/a: 1/1/: ❑ Driveway permits
<br /> vr1`�l (state,county,town)
<br /> ADDRESS: ` `^ / r
<br /> 3 &\ve_-Y1�e'Yv" 0 / ( - C c\,--,1 ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION ? ` '
<br /> PROJECT DESCRIPTION: I : `a A' :'.t ,f'-41;-%e7-:t°
<br /> 45-
<br /> t , �> � ° ', s
<br /> • ❑This project is a new building or structure. 4:`
<br /> *This project is an addition/alteration to an existing building or structure. ` , ,r
<br /> SANITARY SERVICE: PERMIT NUMBER: 14
<br /> �
<br /> ❑SEWER 1 I SEPTIC `''"i ° � , i £ ;
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) i, , .k`
<br /> C j x� fti. .414=4 ,1
<br /> AREA TO NEAREST SQUARE FOOT: ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � , I "
<br /> o M sr
<br /> BASEMENT: 1ST FLOOR:
<br /> 4, TOTAL SQUARE FOOTAGE: ,,I, z o ar �F ��� ,'.
<br /> 2ND FLOOR: 3RD FLOOR: ^ ,
<br /> ® --
<br /> ,�$, �
<br /> ESTIMATED CONSTRUCTION COST: sty
<br /> (Please round to nearest dollar) "� " ' $ I80,Q(x) �� n, '� €;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ISNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? LgYes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 0 No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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 M.No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes Er No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4. -O.
<br /> 545-112(4/08)
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