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SUPPLEMENT to_Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> e W c� Zoning Status;CUP;
<br /> OWNER ADDR- S (Numbs,Scree n El,�.. ''s ,Zip) N L— / Deed Restriction; CSM
<br /> g.3 6 1I$ Cu —Pk( eta,r(9, 11J-T SASS Variance(# )
<br /> HOME PHONE CELL-HONE E-MAIL ADDRESS
<br /> d_o8 6-7:6-- 26 ,Vgr ^ • . •_ I e e a• I (1) ❑Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTR TOR NAM
<br /> _AO a A.. , . s, 4_.1 a ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACT vRADDRESS 1 o of well/septic
<br /> 7L,S Sr Siov h ron Rd-
<br /> (City,State,Zip) (City. t ,Zip) Li / ❑Setbacks
<br /> PHONE PH Pa Ohl 'S?7/b ❑Site Plan approval from
<br /> ( 6O � Z��-2�(s3 applicable township.
<br /> E-MAIL ADDRESS B. ILAD RESS J
<br /> 14. re • aUl a ah/ c600 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑Elevation of property
<br /> ❑NUPARCEL BER frontage drawn to scale. .
<br /> M
<br /> TOWNSHIP. SECTION:
<br /> C VI '/a: ,/,14. ❑Driveway permits
<br /> ADDRESS: / /� ��� �/ / (state,county,town)
<br /> 3i63 f % LOT `owe y g� U /6 I"'Gtr4411 Os---5-8 ❑Sanitary permits
<br /> cs : LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION ,7 17 " �""`7A v1:
<br /> PROJECT DESCRIPTION: ' ` , ,, F ' 5 fi ,,t1'1 ,1•
<br /> i a "e�,l 11. """� '''fit ' r , sou;:,
<br /> O ew • '- • 1 liLA I . CO , , ,
<br /> �i This project is a new bu'ding or structure. =.t-:'' 1 s 'I, '
<br /> ❑This project is an addition/alteration to an existing building or structure. k� ;` y
<br /> SANITARY SERVICE: PERMIT NUMBER: al , �. " ... n ' 2
<br /> - o � haqy�,fi t ��� +;
<br /> r--EWER EPTIC tn °ki '- , 1.a a q TE4 }
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) :w � , .`
<br /> �� # .3" lam r s� , T
<br /> AREA TO NEAREST SQUARE FOOT: ; ,.. i eA :,0 ii r [i
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) f',, 's' . , W,,�� ; 'a £�
<br /> + -"P'� o4tiu 4K O r Oil 2 NI
<br /> BASEMENT: 1 ST FLOOR:
<br /> j TOTAL SQUARE FOOTAGE: + .',t� f .r ;t4;;;V 4.k , wi,Jf
<br /> p Ic7,544.. 1 7'4r -7:141
<br /> 2ND FLOOR: 3RD FLOOR: 2 /�(� .. , lP f z /` g''i 4-h-t �� „, s,
<br /> S Si ]v� � 'p(Ki Fir,,P r'�F �,a b y�`�� t�'��
<br /> V i 3MI- BPS.. n '�+,
<br /> ESTIMATED CONSTRUCTION COST:
<br /> �yy � 1
<br /> ry:�;�' r ,��� a�h 3
<br /> ♦ ♦ ♦ ♦ ♦ ♦ $28 c c a }r �i , 7.4 f �4-,,,r ', 'N
<br /> ', (Please round to nearest dollar) `� �� Mk', ',",it, ,;y l
<br /> r,
<br /> • 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ❑Don't know
<br /> �1 2. Is there a wetland or floodplain on or near the property? NlYes fNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? rgYes ❑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 No ,Don't know
<br /> 7. Is this to correct a violation? Elves No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4► -4.
<br /> 545-112(4108)
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