|
•Z'36 .
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Dole aid CinoEi,a, ,rche r ❑Zoning Status;CUP;
<br /> OWNER ADDRESS (N ber,Street,City,State,Zip)
<br /> c68 3 Like O/i /C aal i 11 f Deed Restriction; .
<br /> HOME PHONE CELL PHON 3�ti l E-MAIL ADDRESS �� Variance #/3�a(o )
<br /> 6o8 23S/(.J) ccoakt al 4 , o, as, ' ❑Site Plan drpwryto scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and include lmensions
<br /> AGENT NAME C NTRACTOR NAME
<br /> �i J?, f Z (01/1.5-176t GJ& ❑Site Play inc ing location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> / q3 e 1,,,r prK c 0,
<br /> (City,State,Zip) (City,State,Zip) ❑Setbatlsa"
<br /> E/C/ I° way/ 4.)1- rfs-ga V
<br /> PHONE PHON / ❑Site PI•; a I-from
<br /> (6o )197 oc,7 ) applic-.1- , ns ip.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> , , a ✓Gt ., 0.A. , .cc, ❑Floor pl V scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation fpr arty
<br /> PARENT PARC LNUMBER:. C�RENT Z ING: ACREAGE:
<br /> ❑PARCEL 034 Y _ `:` - '`�°�1? - _ 0,60 frontage dr to scale.
<br /> NUMBER `�
<br /> TOWNSHIP: - j SECTION: / �� �^�
<br /> r,, 0 r e J ,� V �(0 '/a:it/ 1/41/4: ❑Drive y rmits
<br /> (state, ty,town)
<br /> ADDRESS:
<br /> 7pp era r}/ I oa YCQ61� s--3,5"-7s— ❑Sanity r Its
<br /> 1,° CSM: r(7 LOT J SUBDIVISION BLOC/CLOT (public, ,' i e)
<br /> 'OA;t't. 1,..)w��
<br /> PROPOSED PROJECT INFORMATION `
<br /> STAFF EW
<br /> PROJECT D SCRIPTION: n �
<br /> L !) /114. e �6kr/y1,,,C/ialt. 04/A r'""' 9 ❑ Zoning l Zoning kiyifict
<br /> . ❑.This project is a new building or structure. ❑ Permittt Use?
<br /> OThis project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ I Address
<br /> DEWER aEPTIC r j—v20/q— t°38 S"' (ne /existing)
<br /> HEIGHT IN FEET: NUMBER OF TORIES: (Not including basement)
<br /> I 7 ❑ Wetly . k,• yin/
<br /> Shore a n chment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT: 1ST FLOOR: ❑ Erosion •;tr01 permit
<br /> /1/5-2 213 co + TOTAL SQUARE FOOTAGE: +, (slop P.y , •ante,
<br /> 2ND FLOOR: 3R LOOR: fillln!/access)
<br /> T. '3 2- ❑ Rev :w i+.: Ion Survey
<br /> ESTIMATED CONSTRUCTION COST: Q and �-Il:bl:options.
<br /> (Please round to nearest dollar) ♦ -). ♦ ♦ ♦ ♦ $) 3y� w0, 66
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EINo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Jo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? I Yes o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yeslo
<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) Eyes iziNo ❑Don't know
<br /> 7. Is this to correct a violation? Eyes I to
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —Pr —► —►
<br /> 545-112(4/08)
<br /> VU
<br /> \A-Wi' -'w0/kJ ,ti�i`-� 4-04A_ cou,.0( COY1 . fe ,
<br />
|