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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER�NAM� ±
<br /> �- ✓ ' r 1 . ❑ Zoning Status;CUP;
<br /> O'77".7-'ADORES (Number,Street,Ci ,State, ip) ,.-- , Deed Restriction;CSM
<br /> ♦ % Ara.- ' I c f Variance(# )
<br /> HOME PHO CELL'HO E -MAIL ADDRESS
<br /> ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> A NAME r: CO�CTOR NAME
<br /> ' Try ' C (i ,f ... .■ Site Plan including location
<br /> A6.4,4G
<br /> TADDRESS s: CONTRAC R DDRE S of well/septic
<br /> (City,State,Zip) y (City,State,Zip) ❑ Setbacks
<br /> .. ., ' ."II& (.,.aC)T;: 'r::
<br /> PHONE ,. t. ,t ,4,, PHONE ❑ Site Plan approval from
<br /> 11 ' 1 i-.1*.., applicable township.
<br /> -i. RESS , E-MAILADDRESS
<br /> f i .. :'I. , ° 1I ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ti
<br /> vaon o
<br /> ❑ Elef property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty
<br /> ❑ PARCEL frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: _ SECTION: ❑ Driveway 410 A./'`�"` "'().S ' .1/.: '/.'/.: y perm its
<br /> (state,county,town)
<br /> ADDRESS: l
<br /> ` >� Cr' r ! y � t ' BLCK/LOT ❑ Sanitary permits
<br /> CSU: LOT SUBDSIO
<br /> -t' / (public,private)
<br /> PROPOSED PROJECT INFORMATION I
<br /> PROJE DESCRIPTION: -- . y�K jy s ;
<br /> s_'.--J �� of A '! i'C,e)- cleft) , f
<br /> . ❑This project is a new building or structure. - ,
<br /> ,This project is an addition/alteration to an existing building or structure.
<br /> s _ �x ,
<br /> SANITARY SERVICE: PERMIT NUMBER: sue,.l x� , �
<br /> ❑SEWER EPTIC �. `a -� - ,-,-,,r,.--,.-.,:1
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> :::' s ID iuV`°' a
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) • ' `
<br /> BASEMENT: 1ST FLOOR: ® e �` -. `:
<br /> 4, TOTAL SQUARE FOOTAGE: 4, ,1,,� ', �1
<br /> 2ND FLO`0�: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: i
<br /> (Please round to nearest dollar) 1�° Qt 0,,/'� ° - �2�
<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. Is there a wetland or floodplain on or near the property? ❑Yes 1No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes X.No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ViNo
<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 fi[No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes tig.No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —►
<br /> 545-112(4/08)
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