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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 /> C',4 ee'LP nr`h/eft i f kfS` ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> ,.JJ'-T7 ./`9'.!✓ VieP t--0- /';A< ,.,,�«,401) f;if . 5-....)-----5,-
<br /> ...>"-• 'may' Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 03-.2"—/6 6/ ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 1.i2 ■ "r,:,';' ` ?if<�� " 're /F cf.""tA,"2;171 ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> '. •i
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> ',- ,,‘ • r applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property
<br /> ❑
<br /> frontage drawn to scale.
<br /> NUMBER e 7 C .N —a I t f—!r A / `S
<br /> TOWNSHIP:
<br /> SECTION:
<br /> L` /r��-t `r d u 5'r 'A: A. ' -' Vs%: -t1 ❑ Driveway permits
<br /> (state,county,town)
<br /> ADDRESS:
<br /> _ --- (' °N1 ,1;,, t4 {At, Al- t.--& r ,r, , `.'1/ ,_J-- L > ' ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> 8 a 6'
<br /> PROPOSED PROJECT INFORMATION 1 � '
<br /> PROJECT DESCRIPTION: c` ' '
<br /> a
<br /> ice
<br /> . ` t .:
<br /> This project is a new building or structure. g i ti
<br /> C3 This project is an addition/alteration to an existing building or structure. -m= ,
<br /> �'-' ;; b
<br /> SANITARY SERVICE: J✓J M a'- PERMIT NUMBER: ��`�k's1 �
<br /> ❑SEWER ❑SEPTIC `:,,>, ' ' s
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -
<br /> v �
<br /> AREA TO NEAREST SQUARE FOOT: . -,4,
<br /> rte.
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r'� �- >
<br /> BASEMENT: 1ST FLOOR: s V ��
<br /> ,I, TOTAL SQUARE FOOTAGE: . ,-,,,,,',4,,,.„,...::;,+ :9 ,' �
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> cam- c-----__. 7 R a �,
<br /> ESTIMATED CONSTRUCTION COST:
<br /> —I► —► ♦ --► -4, ♦ l 1 y s • � r�
<br /> (Please round to nearest dollar) .). t� 1i „,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes d No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4i No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? CirYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes gNo
<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 dal No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes Igl No
<br /> 41 6q. 0° APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ■ —► —►
<br /> 545-112(4/08)
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