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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER N E/,A7 G
<br /> ( / 4// ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Skeet,City,State,Zip) ----- Deed Restriction;CSM
<br /> L�/ f✓.97i d/c����d4U� 4.) Variance(# )
<br /> HOME PH E CELL PHONE E-MAIL ADDRESS
<br /> 4 , 7v, ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGEN/AME Vi ge, ,,,f5,1. Al CONTRACTOR NAME
<br /> / - -7■!% c i ,OITTOxir . /cl,7/( L ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 3d q GUk 'C1 C7' -�� v)L .
<br /> (City,State,Zip) t_ (City,State,Zip) ❑ Setbacks
<br /> l- %-ril 4,1// a.1/ 3 S�� C—,
<br /> PHON PHONE ❑ Site Plan approval from��f�-��� Si�'L(E applicable township.
<br /> E-MAILADDR SS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑ NUMBER --��-a' ''H- frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> 1/4. 1/1/: ❑ Driveway permits
<br /> (state,county,town)
<br /> ( )
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION - :I ,
<br /> PROJECT DESCRIP ION: ,.Ae(17 °
<br /> I./ /,J c) - c/ � . @J 5 ��
<br /> . ❑This project is a new building or structure. .. a-- -z. k -;�
<br /> ,his project is an addition/alteration to an existing building or structure. - � �
<br /> SANITARY SERVICE: PERMIT NUMBER: °' -�k: .�, 3
<br /> , e . :+ $❑SEWER 0 SEPTIC C .� a
<br /> jai`--`
<br /> 1-IEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) .,,,,:;:,-,,L.-4,-,-,,,:,,' ,
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> EIASEMENT: 1ST FLOOR: ® _ ' � 4 �,
<br /> 0 �p/- 4, TOTAL SQUARE FOOTAGE: 4 �s, „ ! ° �; ! ,� �� ,
<br /> 2ND FLOOR: 3RD FLOOR: ® 4
<br /> ESTIMATED CONSTRUCTION COST: D � "� � - , ., a:
<br /> (Please round to nearest dollar) '� �7/ '�Ci� �,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No 0 Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes BTIo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement?.., ❑Yes �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) ❑Yes ❑No ,❑'bon't know
<br /> 7. Is this to correct a violation? ❑Yes llo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) –► –► –0,
<br /> 545-112(4/08)
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