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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION, . _; ' <' s" :==-=•.,-"'!-'',;.'::',=--''.
<br /> .. _. � .•w,� ,.::.�: . C .-TOMER TO PROVIDE
<br /> OWNER NAME
<br /> CLf,7— 4 . 6 v R ti(e c s'nti Zoning Status;CUP;
<br /> OWNER ADDRESS (Numbe Street,City,State,Zip) A ed Restriction;CSM
<br /> /g2-6 S ` ,06 4.e-c.'eCy',i ariance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 4 Os.. $7 ' 3 Site Plan drawn to scale
<br /> AGENT INFORMATION.-.: ,' , . . CONTRACTOR:::INFORMATION, and includes dimensions
<br /> AGENA NAME CONTRACTOR NAME
<br /> etrLT A ., v%!�-E-isrFk,
<br /> ❑ ite Plan is .:' . .ca ion
<br /> AGENT ADDRESS CONTRACTOR ADDRESS • .- septic
<br /> /g ZC, S. A�o-0 Z ,t/ i2,t
<br /> (City,State,Zip) 33, (City,State,Zip) Setbacks
<br /> S 7-0-0-4 tl ro-■l� (ALL
<br /> PHONE PHONE ❑ S PIa oval from
<br /> 6 i g-X73 —triff3 cable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Floor plans to scale
<br /> ,
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane co.dane.widus/) ❑ Elevatio
<br /> PARENT PARCEL NUMBER: CURRENTZONINr..+ ACREAGE: ��K P —
<br /> ❑ PARCEL 62:/©0!0-36l_OIO/_r R— 3 f 100• 1 . ,3 W n age drawn to scale.
<br /> NUMBER ,�c, •-
<br /> TOWNSHIP: SECTION: '1/4: � , u Drivewa FR7
<br /> D U//'`!IJ '\ 345 f1/� ,�%/4: Al e,county,town)
<br /> ADDRESS:`!S 2 to S, r 3A ct LIA/ N12, Srey—u .At re/t/
<br /> CSM: LOT SUBDIVIS ON BLOCK/LOT ❑ Sanita rrTl
<br /> L err/ Cou n try C/ b lic,private)
<br /> PROPOSED PROJECT INFORMATION -- A l ,
<br /> PROJECT DESCRIPTION: ,,f3 .t', ,
<br /> /<'t- piA-c l,�roo D bEC� 1 d X' l . °.0 � 8 , ��w
<br /> ❑This project is a new building or structure. Ter =
<br /> This project is an addition/alteration to an existing building or structure. ,
<br /> SANITARY SERVICE: PERMIT NUMBER: °$°� p'1 ' e r ,
<br /> EWER ❑SEPTIC a
<br /> HEIGHT IN FEET: 3 NUMBER OF STORIES: (Not including basement) ' ` ��
<br /> AREA TO NEAREST SQUARE FOOT: ` .
<br /> {
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) . , „,
<br /> BASEMENT: 1ST FLOOR: ., o a o, ® g
<br /> rs
<br /> 4, TOTAL SQUARE FOOTAGE: j , o ; at c
<br /> � c 4
<br /> 2ND FLOOR: 3RD FLOOR: �� ;:� � :
<br /> ESTIMATED CONSTRUCTION COST: m ,.}y.. Ia e
<br /> t
<br /> (Please round to nearest dollar) "� "� 4 -�� , - 4 ®_
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,g-No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes .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? ❑Yes El 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 4 No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes Pa o
<br /> APPLICATION MUST BE SIGNED
<br /> 545112(4/08)
<br /> Q ' (Continue on Back) -0. --► -∎to tc)_ <--g
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