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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 /> In4,49A/i�l e( I2.,A-IKouCki D Zoning St s; CUP;
<br /> OWNERADDRES3(Number,Street,City,State,Zip) Dee R triction; CSM '
<br /> 3882. c.o 04.). b ✓•'i..r-o ct.n+--o,w, Varia a(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6Da"225''3 C185. ' , IOs r , A w ■10 A, . .r• ❑Site Pla dr n to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu s dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> CC.c*IR,'/ 8 u/L0i44 Gcr•cP. ❑Site Plan'nc ding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se c
<br /> /eta PAo a Si.
<br /> (City,State,Zip) (City,State,Zip) ❑Setb*$Cs
<br /> PHONE PHONE
<br /> 1/4,e41,-.4-) , -,
<br /> ❑Site P
<br /> ,,,,,•royal from
<br /> 609-3. _013 appli a I_ • nship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> -MI_ c,44? G.r.4►,c. c. ❑Floor pla to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevate Of operty
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑PARCEL ! p,, frontage awn to scale.
<br /> NUMBER tJ /d6/O' ��QQO S �T�3 13
<br /> TOWNSHIP: SECTION:
<br /> DuNN 7.-? '/a: N£ '/a : 'Nw ❑Drivew�a •-L its
<br /> ADDRESS: (state, „ ,.wn) r'
<br /> Sec c.c.) A $
<br /> CSM: LOT SUBDIVISION BLOCK/LOT '' s C 'L(icy'
<br /> (pu li• I va
<br /> 0' ft
<br /> PROPOSED PROJECT INFORMATION 7- 1."170 C,/
<br /> PROJECT ESCRIIPQTION: eat
<br /> 30 X t �YL44i S Wt 0 II s ° ' :',,0,-;'4';‘,.. ..,' ',,,,,-,,..4,0"14.;k:
<br /> . ®This project is a new building or structure. i '�� y
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: c
<br /> EWER [EPTIC 4 ° ft'
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '
<br /> AREA TO NEAREST SQUARE FOOT: ; 0 :� _ A
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> '',4:>/,'," ,-i:,*',lm II II
<br /> F II II
<br /> ,
<br /> BASEMENT 1ST FLOOR: ( �-v 0
<br /> j TOTAL SQUARE FOOTAGE: + • • • o
<br /> 2ND FLOOR: 3RD FLOOR: ` � "
<br /> s
<br /> ESTIMATED CONSTRUCTION COST: I s 'o s
<br /> (Please round to nearest dollar) ♦ --► --► -► �' .
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? fYes Jlo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? FlYes p❑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? DYes 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 [p to ['Don't know
<br /> 7. Is this to correct a violation? DYes EINo
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) -+ -* -►
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