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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CU-TOMER TO PROVIDE
<br /> OWNER NAM
<br /> c _ T `,,.,`-, /y TL�r.e r y oning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) f c i Deed Re, friction; CSM
<br /> 11 S rr' �� i,5 h 1v.-,,c-tom/, ,� v 7 Varian (# )
<br /> HOME PHONE L PHONE' E-MAIL ADDRESS
<br /> ■Ci'2e5`-7C 3 : Site Ian drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION an includes dimensions
<br /> AGENT NAME / CONTRACTOR NAME
<br /> 5'f e/v-e sh t' Sli t'1.-Y■' j e c.6 C 0 ,f'-/v,-1- 'ur-) ❑Si Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic
<br /> /7 I l ae i/ 14'x, ,. J [-we-2`-2 (.lei/ l'� ,QJ
<br /> (City,State,Zip) (City,State,Zip) ilesetbacks
<br /> .S7 0L...e.)Wfu-1/ c-vl, S3S °7 c LJ-10—'y /, g 3_C,
<br /> PHONE �/ PHONE ❑Sit Plan appr from
<br /> (, 0 Cj, --7 a.. ' ii 7 6 dg . .7 /Z Glrr0'-7, a pli bl wnship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS /
<br /> t,,,� 7`e cam(; dr.vse t 1!� fe eX&MS.n e 4 Fl r plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y
<br /> PARCEL U�I1'3`//-/..10d- c _2, a,U4 frontage drawn t ale.
<br /> NUMBER � 3
<br /> TOWNSHIP: ( SECTION:
<br /> ID c....... 4r P/P'`r4r,1 r 5 4 3`I-6 -"I/ '/<: '/4'/4: ❑ Driveway ermits
<br /> (state, unty,to, n)
<br /> ADDRESS: 5pr,,n -2 ei7
<br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanita •ermits
<br /> (pa,: ,private)
<br /> PROPOSED PROJECT INFORMATION f STAFF REVIEW
<br /> PROJECT DESCR TION: °i p
<br /> e c c� /I5 L,_>'e e-(., &e / wicl e-s 'Ly'S� /ct le9 e-/ �Iel"4t3 Q V oning District
<br /> . ❑This project is a new building or structure. r4 Permi ?
<br /> This project is an addition/alteration to an existing building or structure. 1
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural dress
<br /> EWER ØEPTIC ° (new/ex)stlIIg� /
<br /> HEIGHT IN FEET: . NUMBER OF STORIES: (Not including basement)
<br /> N 2 /e,c / ete,4A ❑ Wetland/FI plain/
<br /> Shorela (attachment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionCOntrol mit
<br /> BASEMENT 1ST FLOOR:
<br /> -71
<br /> cs-; /
<br /> 1, TOTAL SQUARE FOOTAGE: j (slopes,dist ante,
<br /> filling/ac s) ,r)
<br /> 2ND FLOOR: 3RD FLOOR: `)
<br /> 0-6Iej. 1{ et" -4-
<br /> r'�;� ❑ Rev' w Location Survey
<br /> ESTIMATED CONSTRUCTION COST: --I. -1. -1. o and available options.
<br /> (Please round to nearest dollar) Vo
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [21No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Dies .aio ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ,lies ❑NO
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes .®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 'lo ❑Don't know
<br /> 7. Is this to correct a violation? n1'es ao
<br /> 1103 -! APPLICATION MUST BE SIGNED
<br /> ` , (( �, (Continue on Back) -► -∎ -►
<br /> 545-112(4/08) f
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