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<br /> ' • ravode ( 17.7 `l6,r6
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> OG J oning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> 3117 o tsS), .._;-,L,... _>✓Rol• s-6,,,3∎,- -c—, w'L , 5-3ss
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 873- 3173 4,5'8--3173
<br /> Iklite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME i/ C•NTRACTOORNA E
<br /> 'a'``KA/ - C,G6►.t Bus wits 3e vlcc ,..,_< ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 6f"8 707/0e Lo-t- G41 e 1 rlo,^Go-0e "
<br /> (City,State,Zip) (City,State,Zip) Setbacks
<br /> PHONE PHONE �7�1 f i e Plan approval from
<br /> C-08 8-73-68,f/ - gaa``1((3 plicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> S.5A.Je t .._/fl z --VIC) •i(/4- Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property
<br /> PARENT PARC LNUMBE CURREN IN ACREAGE
<br /> P P y
<br /> ❑ PARCEL 0VIC . -gam_D `S e 11 frontage drawn to scale.
<br /> lir
<br /> NUMBER 1U
<br /> TOWNSHIP: SECTION:
<br /> RkS+\�- %: 5 L�%1/<: NW riveway permits ,
<br /> ADDRESS: ate,county,town)
<br /> R& . ,�j1/�
<br /> 377 Sanitary permits
<br /> C : S I LOT SUBDIVISION BLOCK/LOT (public,private) 1 )(.
<br /> PROPOSED PROJECT INFORMATION
<br /> PROtIECT DESCRIPTION: �� '
<br /> >= AASr o,.. t k. Rw1,, I..a.,V,.1 Rw�,, b cc_lc I e . I t
<br /> e;f.
<br /> . ❑This project is a new building or structure. m II
<br /> This project is an addition/alteration to an existing building or structure. ;, n.
<br /> SANITARY SERVICE: PERMIT NUMBER: //�( � °-®
<br /> ❑SEWER SEPTIC e le 'N.�P'r ^- °
<br /> ll�t��
<br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) ' ,
<br /> 18 .. .' °.n .E
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished ared ages and above grade decks or porches) t
<br /> BASEMENT: 1ST FLOOPL .33 01, s # a
<br /> ea t eel .r5 41-"2- ,, TOTAL SQUARE FOOTAGE: 4, ss!n s a ¢ ° K"- , ,,V.
<br /> 2ND FLOOR: 3RD FLOOR: q21
<br /> ESTIMATED CONSTRUCTION COST: oc ° e ptI
<br /> (Please round to nearest dollar) ♦ ♦ '� ♦ ♦ J? 000 , -` K��V
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? a Yes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes VA No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 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 i Don't know
<br /> 7. Is this to correct a violation? ❑Yes '®No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) —►
<br /> I11/C/,
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