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<br /> E3(13o8
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> C_in h e /c 1 S 4 a c SEl,.t 007,-,e 5 r)--- o« --6r094S honing Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 37 t-nom:,, 51 reel- Ta -)4of-, Nk . 7YO Va ' nce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> -7‘ao1.5-104-,c- po.-.-,cS ili4 Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (City,State,Zip) (City,State,Zip) /Setbacks
<br /> ,cXo,,,o>-,x) 1 S 3c736.‘3c736.‘PHONE PHONE Ott‘Plan an approval from
<br /> - S 95/—/6 77 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ,�'Q
<br /> �-"a.Jts 6o•-yes.c,o ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessd 3ne.co.dane.wi.us/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONI G: ACREAGE: P P rty
<br /> ❑ PARCEL frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECT�IIO�N4--
<br /> ��� �� /� ,/4: ,/4,/4: PI Driveway permits
<br /> ADDRESS _____Ayr,._ (state,county,town)
<br /> ( , Lll'Sanitary permits
<br /> CSM: LOT BDMSION �,,). BLOCK/LOT
<br /> S�f... ^ry (public,private)
<br /> F,72f,-s
<br /> PROPOSED PROJECT INFORMATION v , t € ,;
<br /> PROJECT DESCRIPTION: g E't c ..
<br /> C-?nJ e>t - e' Y S, ,I, 1`I�,P ® e E t.t 'E
<br /> . li'This project is a new building or structure. r`, fr ,
<br /> CI This project is an addition/alteration to an existing building or structure. r:::-..; ,.
<br /> SANITARY SERVICE: PERMIT NUMB - € a re-' °' s } ,' '
<br /> ❑SEWER iJ EPTIC �� AZ /: '•
<br /> HEIGHT IN FEET NUMBER O S ORIES: (Not including baseme."— ,,I..,:,,,,,.•- ' £' � •e,
<br /> a� A� 1 I - 4 ad., 11
<br /> A-EA TO NEAREST SQUARE FOOT: `i M P ,j
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) = ""` E , ,
<br /> BASEMENT: / 1ST FLOOR: L$
<br /> ✓�3 -7 lG ✓ ,?e- 3 v°,7, 4, TOTAL SQUARE FOOTAGE: 4, n I
<br /> 2ND FLOOR: 3RD FLOOR: = E.
<br /> ESTIMATED CONSTRUCTION COST:
<br /> QQ�� � . a _ qa#Ya
<br /> (Please round to nearest dollar) "+ "� '� $ G N 9 ,:
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Li Yes Clio ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ifi. Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 1aJYes ❑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) CYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes &No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► -i
<br /> 545-112(4/08)
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