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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 /1 /�
<br /> sJai»6-a 4 �Ge iQi e' .. L(, 1Co( At/ Etioning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> ��Sy t(i ./, -� S/. r;�<�/, 71e,r JS, _5-3 S-C, 7._. variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> -I /)YJu t oc 1, -7 1 t ru r f- C C :di Ehle Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTACTOR NAME
<br /> V 1?-6-6 2 cc SS t_r 1(.' S /e/ v jem f ,,c,/. J El Site Plan including location
<br /> AGENT ADDRESS C NTRACTOR ADDRESS of well/septic
<br /> 18 a s go ,60,r R s (971-)
<br /> (City,State,Zip) (City,State,Zip) aSetbacks
<br /> C X n 1�5 c ,C 07i1.s l.Jy .5-3 S—2 i ,f;
<br /> PHONE PHONE T - [Site Plan approval from
<br /> (.PV g - 7 ct f . 'Z. 2 9 / 5 4-po applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> 6 70. '/'c)/ t'55/-e/O_Mc 50NS.C4..14 s M-34 loor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE: 0-Elevation of property
<br /> ElPARCEL / frontage drawn to scale.
<br /> NUMBER 6'3 2/0 708-t)Gi a/;,�1//-d g/—.T— ^ ``�/�
<br /> TOWNSHIP: SECTION:
<br /> M JC(0,71'hr/4 /' J 1%: SF 1//: _ ED Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> C t* LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION :-.7r-Pe
<br /> PROJECT DESCRIPTION: A ; t
<br /> . ❑This project is a new building or structure. r,`�'i,0444 -
<br /> ®This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: a Ii sit i
<br /> E EWER PEPTIC
<br /> !4
<br /> ?;:-•i 4
<br /> '1 p 1+ y
<br /> ,�r,
<br /> HEIGHT IN FEET:/C) r NUMBER OF STORIES: (Not Including basement) i ,.+ 'x ;
<br /> =17,:,•4":.-
<br /> c, �j/ �I / 1 lia a,a a 1,
<br /> J AREA TO NEAREST SQUARE FOOT: "�_,►' t..... °t! t r
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> ( i C ,, a .lm
<br /> BASEMENT: • 1ST FLOOR: —_ +!"! �?'1 ny i�
<br /> 4 et' 4, TOTAL SQUARE FOOTAGE: 4 I
<br /> 2ND FLOOR, 3RD FLOGft:
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -1 OD . 07. Y> j 6 a
<br /> (Please round to nearest dollar) $ �� �d0.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes to QDon't know
<br /> 2. Is there a wetland or floodplain on or near the property? [Yes o [Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ., !De's No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 0No
<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 DrNo [Don't know
<br /> 7. Is this to correct a violation? [Yes I,,,‹
<br /> rr,, 14-,,,,, ,e [ 83'5- .5887
<br /> APPLICATION MUST BE SIGNED
<br /> 545•112(4/05) (Continue on Back) -i -+ -+
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