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SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE
<br /> OWNER NAME
<br /> 'AT 'd" `DAB-F' N-e^k-r ©e--( (-i', 53583 LI r ning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) I I 6-F D ed Restriction; CSM
<br /> /1 -< U
<br /> NA-,t-7 z-,,-)-) V • nce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 6C'b 8 `1' q616 to Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 1=7,4-«_,r 66.,- „ s0� 4-t C_./ CLi--Se,r-4 ❑Si Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic
<br /> L(3t4- 5G -c16.`1
<br /> (City,State,Zip) (City,State,Zip)
<br /> SG� ✓ o,7t -r�,— / w( S3 G Z etbacks
<br /> ice((-717„Q___-(-02)--, t--1( �
<br /> PHONE PHONE ❑ ite Plan ap val from
<br /> 668 8Z( ,!_)3Z-Z 6, eZ( ZZ p 'ca ownship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> or (� C 4e4/.(-ti, ,t_coa,, ice”( e e.,rr -kmn(e-t.w/1-cdn„ oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARCEL N MBER: CURRENT ZONING:ZONING: ACREAGE: P P Y
<br /> ❑PARCEL 8 frontage drawn to sc .
<br /> NUMBER O�J 0���'3(�2�I j`� A — ` _�y Z
<br /> TOWNSHIP: SECTION:
<br /> -1ow0 6� ).-1,s,i„�-1--cor-c 31- 7-S 1/4: Nil—) 1/41/4: ry F ❑ Driveway p its
<br /> ADDRESS: (state, nty,to •
<br /> CSM: LOT SUBDIVISION BLOCK/LOT I=1 Sanita .ermits...3 1 pub' , private)
<br /> PROPOSED PROJECT INFORMATION '*'/I;'7 %° '',";
<br /> PROJECT DESCRIPTION: / / / � j
<br /> -ferzs6,6z__A / q )( I f frb,, p,eV:'/O,,,,,,,/ o ' ,,, ,,,V
<br /> . ❑This project is a new building or structure. p,';''''';'
<br /> 1 `,,, b'i,,,�� ,_..
<br /> This project is an addition/alteration to an existing building or struct re.
<br /> SANITARY SERVICE: PERMIT NUMBER: !:;;R*
<br /> EWER PEPTIC !�%,„
<br /> HEIGHT IN FEET: NUMBER OF STORIrS: (Not including basement) o �/ .
<br /> I� y;
<br /> r W
<br /> AREA TO NEAREST SQUARE FOOT: '74 ;/4',4144*��'"/,'' I
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '
<br /> BASEMENT: 1ST FLOOR: t! ////,,',F,,,„„f.i., ,TOTAL SQUARE FOOTAGE:3 q 2ND FLOOR: 3RD FLOOR: r4j ;, ;G,'; j'
<br /> ESTIMATED CONSTRUCTION COST: � � , „ ��/;
<br /> (Please round to nearest dollar) '♦ ♦ ♦ ♦ ♦ ♦ Q I �� �/0���j �j/
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 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? tales 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 No ['Don't know
<br /> 7. Is this to correct a violation? :Yes No• .5,W G APPLICATION MUST BE SIGNED
<br /> I (Continue on Back)
<br /> 545-112(4/08)
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