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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
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<br /> PROPERTY OWNER INFORMATION CUSTOM R T PROVIDE
<br /> OWNER NAME I _ L
<br /> La✓re.r•ce_ R,oii1,�l ei.1 ►.� Zoning tatu ;CUP;
<br /> OWNER ADDRESS (Numlw,Street,City,State,�) '/ Deed Restriction;CSM
<br /> 33515 74 ,i. ,,,,�,,q,, �X Very, bU/ 5359,3 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 212- 23o /11,4 N/w ird Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGE IT NAME CONTRACTOR NAME
<br /> rob k 1�r 1•5,_rQ,4L � , ; , Site elan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRES of well/septic
<br /> S7(' ,,e_.--...cP Lr. S7(, L,H4-,virve0 tr .
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> Sc.,a1 Pr -ie W/ 5351t7 ,5m Pv-fur€ N/ 53510 .pr it from
<br /> PHONE PHONE ❑ Site PI.�
<br /> LPN— g ??3 7-f i-$77 3 applic.'.l: t ip.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ' jive_ , .. 'wk. ®Rv/Cam • ovdt,. r- ,e ✓t®AoI • LO>�n �I
<br /> Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1 Elevation of PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: . oproperty
<br /> ❑ PARCEL frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION: ,�f
<br /> M1 -Ztf-, ' : '/1/<: �`t' D r' rm i
<br /> (s o my own
<br /> ADDRESS: n
<br /> 33115" /4, w,d.w Q�C V1 till 5:36Y3 '. Sail 9,,4 its
<br /> CSM: LOT SUBDIVISION BLOCK/LOT r,,
<br /> ',,� r
<br /> PROPOSED PROJECT INFORMATION —
<br /> PROJECT DESCRIPTION: n ; >
<br /> . I1 This project is a new building or structure. t. 4 °��
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: F ° •°°
<br /> ❑SEWER ❑SEPTIC _
<br /> HEIGHT IN FEET: , , NUMBER OF STORIES: (Not including basement) j I�
<br /> '/ / / e a e E v- 7
<br /> AREA TO NEAREST SQUARE FOOT: "
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t `' A 1/
<br /> ° • q a ° ±
<br /> BASEMENT: 1ST FLOOR: ,, 1
<br /> "'hi Z 4, TOTAL SQUARE FOOTAGE: + °o° , ,. /
<br /> �/ � ° R "`z
<br /> 2ND FLOOR: 3RD FLOOR: /z- 0
<br /> N/4 ^//w //S-2, i a : °- -ESTIMATED CONSTRUCTION COST: $ 2e /h0� a - . ,., a ' i"'�J G
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ "� •p V
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes allo LI Don't know ,�
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes f No LI Don't know c)/(�
<br /> 3. Have you talked with the township about your project and are they in agreement? DYes 0 No Ii Tti
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No
<br /> 5. Is this project a . ' rezone/CUP/variance tition/appeal# ) (leave blank if none)
<br /> 6. Is a lo to survey required? (see re ,se) NYes ❑No ❑Don't know
<br /> 7. Is this rrect a violation? „_.•-•" ❑Yes El No
<br /> APPLICATION MUST BE SIGNED
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