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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER..INFORMATION :. _! :::,{! `P }ry,,j .-'. .i.:_: r ' CU OMER TO PROVIDE
<br /> OWNER NAME
<br /> °"rte- S eAs Tom\ L Zoning Status;CUP;
<br /> OWNER AODRESS (Number,Streit,City,State,Zip) D ed Restriction;CSM
<br /> Vag- C4t ri 5--11-artS0r. Ave Kant E'S 0). , t1,-II c -7 I 1 ariance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> . 8 g.5"13-2_03 El -i - •l t- 9 °-co— Sit Plan drawn to scale
<br /> AGENT INFORMATION.;: , ;,. CONTRACTOR:INFORMATION d includes dimensions
<br /> iiiii illinlirdilli CONTRACTOR NAME
<br /> Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic
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<br /> (City,State,Zip) (City,State,Zip) S etbacks
<br /> PHONE ..___�t PHONE CI Slte Pla�z{a rom
<br /> CJ I) OA/ cable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ ans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.codane.wi.usn Elevation of property
<br /> PARENT PARCEL NUMBER: CURR TZONI ACREAGE: P P rty
<br /> ❑ PARCEL Q frontage drawn to scale.
<br /> NUMBER 471d�5� 'O(A8v' Z � '�� � '1 l g
<br /> TOWNSHIP: .
<br /> g16o ∎∎ -rove OS IA: OE %l/: Ne ❑ Drivewa Irr 1 s
<br /> ADDRESS: county,town)
<br /> S•-1c) Ckris4-10,n"S'"'1 R.re` ❑ Sani -• • rmits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> li0(O C( de, . t ,•her p,t-k :••lic,private)
<br /> PROPOSED PROJECT INFORMATION .
<br /> PROJECT DESCRIPTION: a ,„ " b
<br /> Ve.A i 2'Ai Sfi, deck w'\ ruw drz e� �` ,t` e"-pi.`
<br /> . ❑This project is a new building or structure. _ G o g
<br /> ®This project is an addition/alteration to an existing building or structure. x. 7.'tr , mt A°
<br /> SANITARY SERVICE: PERMIT NUMBER: i- . -y-°.'f ; - .--.
<br /> ;��
<br /> SEWER ❑SEPTIC E
<br /> HEIGHT IN FEET: J NUMBER OF STORIES: (Not including basement) , ,,
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1; i ,„ i
<br /> BASEMENT: 1ST FLOOR: g.: 6:-
<br /> �y I
<br /> ,
<br /> _ q .
<br /> "1:71.4.;-74"Y',4:"
<br /> ,, TOTAL SQUARE FOOTAGE: ,, ' L- '
<br /> 0
<br /> 2ND FLOOR: 3RD FLOOR: Y 1 l � £
<br /> �z, F�;Y? :, y ,4 1` .'P
<br /> ct �}A-ESTIMATED CONSTRUCTION COST: �' 0 001`213=W1(Please round to nearest dollar) -► -► -► -► -► '1 $ HOC) n ,...,-.:%.-_,--,t...,.......,..-.,..,
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes CStNo ❑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'? gYes ❑
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Ye :ter
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (le a blankif none)
<br /> 6. Is a location survey required? (see reverse) Yes ❑f( ❑Don't know
<br /> 7. Is this to correct a violation? LI Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> s (Continue on Back) -► -► -i.
<br /> 545-112(4/08)
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