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ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App#
<br /> w
<br /> PROPERTY OWNER INFORMATION °:r ,':' CUSTOMER TO PROVIDE
<br /> OWNER NAME / /�
<br /> AGA)∎9Id V. 3fn�� eiti4 6 th(S G.QFF.rJ I-4C ❑ Zoning Status
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) r. Deed riction;CSM
<br /> .3560' T'.....`f 4/A-we G ptaSS f L.4 r 441 wJ lance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 198 - '1 417-5-9 $Z6-/aio 0 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> -SAstA- 416 ,5, 8 p v� 4frtkij t a op r"y IN's 44C Site Ian including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic
<br /> 6Jr2cG44.1,4 7-67.0 1 A,o2I
<br /> (City,State,Zip) (City,State,Zip) a acks
<br /> PHONE PHONE O r so.4 S l, Ge,� 5 3 7 /9 ite Pla a rom
<br /> 6039- T.24 - /045 a licable township. 4._
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Fl r plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) levation of property PARENT PARCEL NUMBER: e CURRENT ZONING: ACREAGE: P p rty
<br /> ❑ NUMBER 4.•S40 467"Ggj'9$ // . L.C -/ a..S3 /9c J) fr tage drawn to scale.
<br /> TOWNSHIP: SECTI - 11
<br /> S DR l tU9d 4 c€ I 1/4: N 1/41/4: f ) IN) Driv- ..•-• I, /�/ -t-
<br /> at: count town /" �1
<br /> ADDRESS: Q 11/41
<br /> a 938 Cfy • f,�wy. P. 1117`• el ait,E,� ❑ Sanitary •
<br /> CSM: LO SUBDIVISION BLOCK/LOT
<br /> Q 92.(/ =(.3 (p ,private)
<br /> PROPOSED PROJECT INFORMATION = .c..:'07,''',",..-1";V:R
<br /> PROJECT DESCRIPTION: �� r • , ``
<br /> - . . -aa.._:ausit■rg-..■ ' 10 P,,5,='-`"!..4::(170 ,'",.,11-41:c t:, -."-'■,,, ...;,-,4ti...-il
<br /> 0 This project is a new building or structure. G /1 .S, K 3- F
<br /> ❑This project is an addition/ eration to an existing building or structure. . ' �
<br /> SANITARY SERVICE: PERMIT NUMBER: ' "* T " -2-!.. {
<br /> ❑SEWER SEPTIC a ', '`
<br /> HEIGHT IN FEET:ET: '` NUMBER OF STORIES: (Not including basement) }° '� --,;igt'r : k
<br /> AREA TO NEAREST SQUARE FOOT: ti -
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ri:
<br /> ,- - ' "
<br /> BASEMENT: 1ST FLOOR: 7�` � ® w ar
<br /> :°
<br /> -- O '— _ . A ■ 1 TOTAL SQUARE FOOTAGE: j g d ��
<br /> 2ND FLOOR: d ^ 3RD FLOOR: - ':
<br /> V �
<br /> ESTIMATED CONSTRUCTION COST: " are ,, a. ',.:41',„,,,,a -.V--,j' 4
<br /> (Please round to nearest dollar) "� "� "� ,
<br /> /op, Oa
<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?4444 Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? SJ Yes ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 9'it a ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) AYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ., No
<br /> 4 ) ,/� APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) 1`'f1 U (Continue on Back) ■ -4. —►
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