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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 /> ,eg 7 e`'q ""a'mcc- - oning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 4-2,0 0A-094KS JF Go •i-r. Aj/D0 (N/ 5 35GZ Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> &o8-5Z7-423 Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 774f0" 4,JZtr� CONTRA, QEI1/44i a ea/c,Mf/iIC. ( Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 7Q2-3 4-'mar A• .
<br /> (City,State,Zip) (City,State,Zip) Ell Setbacks
<br /> Mfbate; .4 ct / c35-64
<br /> PHONE PHONE / Site P n approval from
<br /> (oo$- 8;I¢g ZZ app' able township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> F.QA^/ZEPJ g 4044:014.80/1414.1 %I Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) IW EI on of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty
<br /> ❑ PARCEL o e drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> T 0;C. ROa LET�� ,/ %I�' I Driveway ermits
<br /> (state, unty,town)
<br /> ADDRESS:
<br /> 4288 ,Q 41044CSMA.le Cavern
<br /> CSM: LOT SUBDIVISION BLOCK/LOT �.Sanita permits
<br /> L-,Uk k (p c,private)
<br /> PROPOSED PROJECT INFORMATION I 77,
<br /> PROJECT DESCRIPTION: .
<br /> c- P t �7L 8 f ?
<br /> '
<br /> • ❑This project is a new building or structure. of S-- ti
<br /> "Willis project is an addition/alteration to an existing building or structure. 4
<br /> SANITARY SERVICE: PERMIT NUMBER: ' rA fe,'� a = y
<br /> • , ax '
<br /> ❑SEWER ❑SEPTIC ' a �1 ���'�� ' ,
<br /> HEIG N FEET: NUMBER OF STORIES: (Not including basement) -'
<br /> ..// : � d ; `V -I
<br /> A Z-- a L
<br /> AREA TO NEAREST SQUARE FOOT: .,..,,,-t A
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> gt w _,.
<br /> BASEMENT: 1ST FLOOR:
<br /> gam/ „JP ,� TOTAL SQUARE FOOTAGE: ,1,, ` -I �,� ';�1
<br /> 2ND FLOOR: 3RD FLOOR: ,s,,x
<br /> 8 , ,,, l .,rya ,„ 3
<br /> ESTIMATED CONSTRUCTION COST: -„ , . ,- ,
<br /> (Please round to nearest dollar) ♦ ♦ ♦ --► //a �o Ea .,. '
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes L I ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? L4*es- ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes aka-
<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 CaThi--- ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes gicri
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -i -* -►
<br /> 545-112(4/08)
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