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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> R"1"`'J A^`I.4.-, ^ Zoni tatus; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> 205`1 6)4,-;,, C;,,I& C'-oss pi,,,,s wz Ti7Z8 D d Restriction; CSM
<br /> ariance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 1OS-27dl-079t/ ri'�1,,,aAa,c4.-r e w q;i,(o ❑Sit Ian drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 1)r ew; So Imlr ❑Site Pla cluding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/
<br /> 317_ tA/ I,✓;Is,., 54.
<br /> (City,State,Zip) (City,State,Zip) acks
<br /> Hc,,,t's� 'I wZ r ?7n3
<br /> PHONE PHONE ❑Site oval from
<br /> 60; 6s$ Ltz$S appli township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> w,G(rPwr e etre,,,s (,✓,L '' ❑Floor p s to scale
<br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevati.• •f property
<br /> ❑PARCEL l ^ (/( fron - .e •rawn to scale.
<br /> NUMBER �I (�`7.^,.� ()Si S'S SO I C `I ' I
<br /> TOWNSHIP: /SECTION:
<br /> VEr`"'D .t '/a: '/a'/a: ❑Drive y rmits
<br /> ADDRESS: (state, unty,town)
<br /> gm P/e.sgr* V4 2d
<br /> ❑San : • -rmits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (publi •rivate)
<br /> PROPOSED PROJECT INFORMATION a'Odg F REVIEW
<br /> PROJECT DESCRIPTION: 1
<br /> ZS- s. i... r J,va,;L (�) j rend ✓.1 - )1)- oning District
<br /> . IEThis project is a new building or structure. P Use?
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBS 1 ❑ Rural ' ••
<br /> EWER , EPTIC IN/ �h (ne ing
<br /> HEIGHT IN FEET: 9 N NUMBER OF S ORI S: (Not including basement) loodpiain/
<br /> ❑ Wetian•
<br /> Oreia me i
<br /> AREA TO NEAREST SQUARE FOOT: 0 „.4
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Eros'. a
<br /> BASEMENT 1ST FLOGR Co el Permit
<br /> ��- 1 TOTAL SQUARE FOOTAGE: 1 (slopes, • turbance, 0(
<br /> Min. - - s)
<br /> 2ND FLOOR: 3RD FLOOR: 1-4 9 ❑ Revie o , 'on Survey
<br /> ESTIMATED CONSTRUCTION COST: -+ ♦ ♦ _ ♦ ♦ $ �' '� and av- '-•le options.
<br /> (Please round to nearest dollar) .p ,,
<br /> \
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ElYes ❑No ['Don't know
<br /> 2. Is there a wetland or flood lain on or near the property?
<br /> p Yes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? aYes alo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ❑No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#)1% ) (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 o
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) -► -►
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