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<br /> • Locoulio-A -'".)e-L?s ....../j ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NA _
<br /> /'C/Cie / C �'^'E" l5 ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> 3/�/ C cv / rc .(w Deed Restriction;CSM
<br /> v P �f/ �;eb W i 535 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> `�/4 6Sc-7 Lico
<br /> Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> enc. kG. 1 --C.. a n,c' IS ite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS Of ell/septic
<br /> 3 t3> /,&v P .
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> /'vA f Hors-1n L I 535=.7 7
<br /> PHONE PHONE Mite Plan approval from
<br /> L-//y 6,59 49 i ' applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> - FI or plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/)
<br /> Elevation of
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG : property
<br /> 0 PARCEL c� ,4/ frontage drawn to scale.
<br /> NUMBER OW L/i/.5 U n
<br /> TOWNSHIP: SECTION:
<br /> �
<br /> P;^y�G .1/4: x/41/4. 11<riveway permits
<br /> ADDRESS: Al j (state,county,town)
<br /> '�/c7/ ( e.4 y /1,-5 Ac we,/ �� ,-y// A e J c-.-'c_ 5-3 5 7 2
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ( permits
<br /> 1`�` (public,private)
<br /> PROPOSED PROJECT INFORMATION y
<br /> PROJECT DESCRIPTION:
<br /> (•
<br /> . ErThis project is a new building or structure. a;0 4
<br /> ❑This project is an acjdition/alteration to an existing building or structure. ,} ,
<br /> ,SANITARY SERVICE: ) PERMIT NUMBER: , e .i
<br /> ❑SEWER 1'1%•SEPTIC ft.1-,- ,
<br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) �rn .;;,
<br /> /��- mean ',e,g- I ,-':,r -'',t!-7'.,!",` I''''''' .
<br /> Y t �,
<br /> AREA TO NEAREST SQUARE FOOT: � ��`�-�
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , ,
<br /> ® t r i r
<br /> BASEMENT: 1 ST FL OR: i/ )X 50 ,I, TOTAL SQUARE FOOTAGE: 4, *- , i
<br /> ...4-Z.
<br /> r!`
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ -F-�,p 00 , .. ,i-
<br /> (Please round to nearest dollar) -,-.,„z.::,... .--:7-1,,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EiNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ° No LI 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 2 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 ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ®No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► ■ -►
<br /> 545-112(4/08)
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