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SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME S O A , • I
<br /> S'Afi/4 tea- 1- ' 0136") Pk Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 3 07 K©s k Ik e cin.)o, Dr ,EdQercoti L J is 53S3 5/ Variance(# )
<br /> HOME PHONE �8 CELL PHONE E-IirAIL ADDRESS
<br /> 1' V' %•' .— b& Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME / CONTR`1CTOR NAME p�(
<br /> ��LA/�}41/t/r PG(/UT D(e D ,q,,u /S c>~+g ?, y?e,,try It-.t. ' t'W-Sy' -n including location
<br /> A ENT ADDRESS CONTRACTOR ADDRESS s .0,
<br /> 3,24 s-t./P6i /o 4a
<br /> (City,State,Zip) (CtState,zip) ,S Q xi )N Setbacks
<br /> Ed g erfa✓ W is 5353
<br /> PHONW PHONE Site Plan approval from/ IS-
<br /> L08 _ Ssd/- 9s2/ applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Floor plans to scale
<br /> PROPERTY/LOCATION NUMBER.INFORMATION (httpR/acczsssddane.c".dane.FwGE s/) I.i Elevation of property
<br /> ❑ PARCEL _ 4 Sti, 8 frontage drawn to scale.•
<br /> NUMBER r - A �" C�.
<br /> TOWNSHIP: n // SECTION: /\j' ^-
<br /> T Lt1A) cr ,4/.6/D.) � ' :Ms-Ai '/a'/:it/.2 itt Driveway perm,�it '1�yy rKJ
<br /> ADDRESS:
<br /> (state,county
<br /> :3(77 k'oSk j. On.)3 Dr. t ry permits A
<br /> CSM: LOT SUBDIVISION :LOCCJLOT
<br /> p 2, /3 / /6;47 �kory/ //L,SAt. ,� blic private)
<br /> PROPOSED PROJECT INFORMATION 9t 4•
<br /> PROJECT DESCRIPTION: s!;� r k ,,
<br /> !�', ,1
<br /> ❑This project is a new building or structure. € F
<br /> !-
<br /> This project is an addition/alteration to an existing building or structure. .,, `i h E . '':h
<br /> SANITARY SERVICE: PERMIT NUMBER: • n°A'° . ,. F
<br /> Xj SEWER ❑SEPTIC ` '' " ,
<br /> ,
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , ,- ; D11 /
<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 ' h <-
<br /> p�)`g,�Q 4, TOTAL SQUARE FOOTAGE: 4, 7 ''"#",,'"a°,
<br /> 2ND FLOOR:(7 3RD�OO�R: � '° m v-
<br /> 3/og t;',:m,?4#4114,-&arti:71-q,,t4it-A-iii?
<br /> ESTIMATED CONSTRUCTION COST: e,
<br /> (Please round to nearest dollar) "■ �� _ � /, ; :; -t ; � �_
<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 No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? II Yes 2i No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 2SlNo
<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 ®No ❑Don't know
<br /> 7. Is this to correct a violation? DYes 5i1 No
<br /> 545-112 p(s--y,5112(4/08) D 0 APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ■ -* -I.
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