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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#
<br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE
<br /> OWNER NAME `�9rj
<br /> /(�� y- e_'" ie///,Z IL Zoning Status;CUP;
<br /> OWNER ADDRESS ber,Street,City,st e, IP) iii/ ii D ed Restriction;CSM
<br /> &/OQ 2w fig/5 5359 3 ariance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 3, 5-5779 (095-3/4 0 . t-G614/6-56fds,ne!" Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDR S if well/septic
<br /> (City,State,Zip) (City,State,Zip) 1.1t1 Setbacks
<br /> PHONE PHONE ❑ S - Plan a:• • - rom
<br /> - •• a•le township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> J - oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y
<br /> XPARCEL 3) a5. _gp� 5-- R1.1- ( , . 8 frontage drawn to scale.
<br /> NUMBER O� l! n Y
<br /> TOWNSHIP: G SECTION:
<br /> >/e 6— -- 1/4: /0,1/ %IA: SE ❑ Dri ve er-rrnts�
<br /> ADDRESS: state,county,town)
<br /> °WOO 14.; //� /'� ' ❑ Sani rmits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> CO lic,private)
<br /> PROPOSED PROJECT INFORMATION `
<br /> "PRO ECa DE CRIPTION: �� Zto.,,,,,,,-
<br /> G)L5 0Y� �� / air ee eti
<br /> ❑This proje is a new building or structure. �
<br /> Nt This project is an addition/alteration to an existing building or structure. W . :-f
<br /> SANITARY SERVICE: PERMIT NUMBER: ®i ,7). o
<br /> ❑SEWER Pit SEPTIC `°
<br /> ---\r
<br /> HEIGHT IN FEET: O �� NUMBER OF STORIES: (Not including basement) „-1 ,rnamirin-,...;,..._!-:;,,,,,vl.
<br /> -,..,;?,',2:41117:-..,1.', �`` ,,",a,`%'
<br /> AREA TO NEAREST SQUARE FOOT: .-”
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) " a
<br /> BASEMENT: 1ST FLOOR: e • • '
<br /> V ,, TOTAL SQUARE FOOTAGE: j •° t
<br /> if :
<br /> 2ND FLOOR: 3RD FLOOR: A40
<br /> =4 i=eptitiqiittp,t4a:-.2.7 .
<br /> ESTIMATED CONSTRUCTION COST: e oy:€
<br /> (Please round to nearest dollar) "■ " ' ♦ ♦ ♦ --∎ $ Lib 0 ('� ,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 5rNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 54No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes YiNo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? AYes ❑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) DiYes fil No CI Don't know
<br /> 7. Is this to correct a violation? VYes rA No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) –► –► -♦
<br /> 545-112(4/05)
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