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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME '/
<br /> D0t''` ,k ? 4//'°-') ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,S�fpe City,Stat /,� (nla✓e �/ ��35"Z7 Deed Restriction;CSM
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE -MAIL ADDRESS
<br /> 373-P/37 LI Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGE T NAME CONTRACTOR NAM
<br /> r
<br /> '` ' " 'J n Bste_r ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> S-76 /,,.,/t¢,-J O,^. s�4 L;.1n eri,dC D•-
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> .5„ P,'a.,i,(e `✓/ �3 S"fQ Sv n Pr i✓I e_ `'L)/ Sd 5-9
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> ggz/_17 73 'Pig-yg-S 77 3 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> 'e,,,# -.4,-- ,ery 440/•C-- ''"1 ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property PARCEL❑ NUM ER 6/8/07//-3`/.3'900-/ 14) /e. / frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> cleiJ e_ (,tee 3'l 1/<: 5 kJ %'/: SW ❑ Driveway permits
<br /> (state,county,town)
<br /> n)AES
<br /> 23 37 .5c4-ta i RS t , - L '€ w/ .5-3-5- 7
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION n BLOCK/LOT (public,private)
<br /> /v!A mddS S ,Be. 5 A/04
<br /> PROPOSED PROJECT INFORMATION a ". I e
<br /> PROJECT DESCRIPTION: jj
<br /> t P4/c B+--f 73 41 " a 3 1 --
<br /> 6 �
<br /> his project is a new building or structure. g��� �
<br /> ❑This project is an addition/alteration to an existing building or structure. - � r :'
<br /> ,a A , e 1 -
<br /> ,,
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> ❑SEWER ❑SEPTIC - --3':=L:
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1
<br /> /51 7„ °' '1 W®/ tt:,:�
<br /> AREA TO NEAREST SQUARE FOOT: _ "� ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 t '"
<br /> BASEMENT: / 1ST FLOOR: 1 ,
<br /> Nf /&00 PV ,, TOTAL SQUARE FOOTAGE: , ,,yy ,.,42.,.\:.4.,.':,Ea
<br /> ''9 ® o - ,N;'.4-•!;:14 d
<br /> 2ND FLOOR: 3RD FLOOR:,NM- /602 �
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) ♦ �'■ ♦ "♦ $ 37, O� ..4 _______
<br /> �n _
<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 ®No ❑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? 4Yes ❑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 0 No ❑Don't know
<br /> 7. Is this to correct a violation? Li Yes .14 No
<br /> s
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/05)
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