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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 /> Q l!ew(,od p r vte I< L LG •
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Sta P;
<br /> /90 9 4"r�et Pt 4-ue, ' -y Dee stt7ction;CSM
<br /> 1 V lance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> -e j f'_L.3 7-- 2(`9— 0of-115-5936 -i.1., a(ncKeh r i p. c_ew, ite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> G;.6 P°`'Ken 57e/lf' ❑ Site PI eluding location
<br /> AGENTADDRESS CONTRACTOR ADDRESS
<br /> I/septic
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> Add<sett (-2 /' 5370`f
<br /> PHONE ! PHONE ❑ Sit PIa proval from
<br /> 60, -z,(.�I -L7 0 a • ble township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> X4,6 @ d0 ite/I rQ4/} • eor- or plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usr7 Elevation PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: oproperty
<br /> ❑ PARCEL O3,Z / ©7CPT. /�_ )� -? C ^ I ' frontage drawn to scale.
<br /> NUMBER 7 I
<br /> TOWNSHIP: SECjI
<br /> G(d(fWvv-- (& ,A: ` ,/a,/. . ❑ Drive permits
<br /> ADDRES ( e,county,to •
<br /> 13 8 2-641-.6'(..e0 d C rJenf AtlnG
<br /> ❑ Sani -• •ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (• .• ic,private)
<br /> L4 V e cjoo d,64142/6 (co 49 nom"°
<br /> PROPOSED PROJECT INFORMATION # w
<br /> PROJECT DESCRIPTION: t , "
<br /> 1�/L @ 14 -(6�- (e0,2) ( fix (c.% ( �
<br /> . ❑ ' project is a new building or structure. f�
<br /> T
<br /> KU This project is an addition/alteration to an existing building or structure. �£. , .,}
<br /> SANITARY SERVICE: !R1 PERMIT NUMBER: ''
<br /> LISEWER 2-1 PTIC z ! z0 ' ' 1,1
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> it
<br /> AREA TO NEAREST SQUARE FOOT: ' 1 0 1 . � d
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' ° '44.
<br /> BASEMENT: 1ST FLOOR: �� 4, , �i , „€ �
<br /> 4, TOTAL SQUARE FOOTAGE:
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> teo ,,,„..„.,„:,,,„ . .„,„,„,„„,,... ,Priz.i,
<br /> ESTIMATED CONSTRUCTION COST:. . $; ,�, ,1: d
<br /> (Please round to nearest dollar) 'r ♦ ♦ ♦ ♦ /��� ,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes LT-No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EffNio ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? LYes ❑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 Er,,,, NNo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes LyNo
<br /> (----- APPLICATION MUST BE SIGNED q k 545-112(4/08) G
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