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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME ' n, �
<br /> Pt If'r6 IV'C (MX •� ❑Zoning Status; CUP;
<br /> OWNER ADDRESS Number,Street, ity,State,Zip)
<br /> ��//// l�'f'�� Deed Restriction; CSM
<br /> HOME PHONE pEJi✓ ELL PHONE , l/ ADDRES 351 3 /�, Variance(# )
<br /> [.�/A-
<br /> 14 '2 ' - - I 6,0 / /L '4 i ' /10-6 ❑Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> J II t rt,,,,Ft 6 �d� �;�'/ ji.Q, ❑Site Plan including location
<br /> AGENT ADDRESS CONTRALORADDRESS �" of well/septic
<br /> SAM - 9C53OPOILC ',k 4
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> l �►U�-a,_ v 5 3.CGr,
<br /> PHONE PHONE c�,� ❑Site Plan approval from
<br /> fat'4 �) o5 applicable township.
<br /> E-MAIL ADDRESS MAIL ADDRES
<br /> • / A laiiiiArkt Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (htt p://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property
<br /> ❑NUMBER D So9 D92•X3210—SECTION.
<br /> 1-Z -to . O ( frontage drawn to scale.
<br /> TOWNSHIP:
<br /> P O` r()c 1/.: '/a'/a: ❑Driveway permits
<br /> ADDRESS:-' I t ? ' / (state,county,town)
<br /> 7225/ V/%0GJ ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION STAFF EV'1` ,
<br /> e ,,
<br /> PROJEC DESCRIPTIO 'ig1' ' -
<br /> 1r ,, ,` Sbw ;,t, svw S s ma
<br /> . J`This project is a new building or structure. ' , .,i ce'4,44
<br /> -
<br /> ❑This project is an addition/alteration to an existing building or structure. f.:4-i,. ..4,,,,,�� .i •r.
<br /> SF d es ," ,,, 1.
<br /> SANITARY SERVICE: PERMIT NUMBER: °*�"cJ
<br /> 16.11))1ys i4
<br /> EWER IdEPTIC �k ,„ r�""�
<br /> HEIGHT IN FEET: 2' NUMBER OF TORIES: (Not including basement) tt P ,.►j� .. '
<br /> . : oral l�an -a a T11 i' --
<br /> AREA TO NEAREST SQUARE FOOT: ���� o� % ' i.� c.
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) tip'. *-2 1Q Control p 1
<br /> BASEMENT: 1 ST FL�R: / ' TOTAL SQUARE FOOTAGE: 4, � S'tu7 a Ce
<br /> rte% o e t Q
<br /> )I[n.49 S
<br /> 2ND FLOOR _ -_ � +i/��_ i_�''�1,7 _��_ �`' a � '�. ��r- "` ����,,,
<br /> c.ft %yam
<br /> wiwAr ESTIMATED CONSTRUCTION COST: �° Tl;� ,o e p ..'
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �4, V ,tr ' z
<br /> I Om-
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond/or lake? ❑Yes alo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? . es ao ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? _,, H' es ❑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 eli o ['Don't know
<br /> 7. Is this to correct a violation? ❑Yes j!� o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -
<br /> 545-112(4/08)
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