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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNE E
<br /> il/L)\}t." \-1,c-1, c. ,, "I-0 c. ❑Zoning tus; P;
<br /> OWNER ADDRESS (Number,Street,CO,State,Zip) Deed Res • • n; CSM
<br /> / 00c b &) KG( / 7 a)ti ZO rn 4 vt /C /..)...17 S 3c(vD Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> /g - l''1 5,g" 9ePO 6 ❑Site Plan d wn scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes ' ensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> gr e k to 2 r tC,A JAN_ CONTRACTOR ADDRESS ❑of Site Pla well i p cl ing location
<br /> AGENT ADDRESS
<br /> /00a(. 5, Rd i
<br /> (City,State,Zip) (City,State,Zip) ❑Se s
<br /> /114 .• nnAVtic , LUG 53S-1.0
<br /> P,IONE PHONE ❑Site Pla app val from
<br /> etg 3 S K- fo 0 L. rr `g`f 5 (-t' l3 applicabl t nship.
<br /> EMAIL ADDRESS E-MAIL ADDRESS
<br /> ❑Floor plans ,ale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation pro
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> j
<br /> ❑PARCEL i frontage dr to scale.
<br /> NUMBER (��� 113-' b 0 — �r
<br /> TOWNSHIP: SECTION: I_i
<br /> U / � '/:NW 4 '/'/: I/`f`
<br /> ❑Drive Y ' 4MQ2.0mah ■C � 1/ '
<br /> ! r l
<br /> ADDRESS: , (state ••• ! , •wn)
<br /> •
<br /> loom �w71 I 420 ALI , (j S36-4O-
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑sa %�,.e)
<br /> PROPOSED PROJECT INFORMATION
<br /> PROJECT DESC I TION• _. +"- 0 -''4
<br /> .
<br /> This project is a new building or structure. ��4 , �� '
<br /> ❑This project is an addition/alteration to an existing building or s ure. r , ��" . ;1 M'
<br /> SANITARY SERVICE: PERMIT NUMBER' _} qI 5 •m x w'
<br /> EWER EPTIC Ilr�l I A j I x - r rv� t t ;.
<br /> HEIGHT IN FEET t NUMBER OF STORIES: (Not in.udi e - rrt) % ` *u44,r _ ° 0
<br /> ` �r,� t 9 r•(i f a-` '.:
<br /> fii`�t rH r t a "
<br /> AR TO NEAREST SQUARE FOOT: .. . .t {
<br /> (Outside dimensions uding unfinished area,attached garages and above grade decks or porches) Y ,a,",,,,,',.„, ,,,
<br /> A BASEMENT: 1ST FLOOR: r„O �' '-, •1 ;1 ES
<br /> +, TOTAL SQUARE FOOTAGE. 4, 1. y
<br /> C
<br /> 2ND FLOOR: 3RD FLOOR: &2 ., ..7,..t:V - Y-,%,-,'.--, { .
<br /> V ra iT ,.� r 9 t1 rI t..
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ QQ�� III t��+ '; • ;'
<br /> (Please round to nearest dollar) 'P � v � ;?
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes Dlo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ®Yes o 00on't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes lo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Olo
<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 61 o ['Don't know
<br /> 7. Is this to correct a violation? [Yes P, o
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(arose (Continue on Back) —► -4. —►
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