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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION /� / �f' CUSTOMER TO PROVIDE
<br /> ONMEq NAME 14 c f A n.l r,�` A. A font st t�..J J- . 1 _1 1:4
<br /> OY*4EERR� � (Number, l•'►City,Slate, Zoning Status;CUP;
<br /> 2i9)""`"C9° , e f �S S'3 Jo Z� Deed Restriction;CSM ?�
<br /> 'X'�- y" ' "r "°�t Variance(# )
<br /> HOME PHONE CELL PHONE E-MAILADDRESS
<br /> 64 -$34-S2. 7 Gill .235- 9?1 7 h ® W�+:i 6 run corAS.c.' ill Site Plan drawn to scale •
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4 Alc-
<br /> AGENT CONTRA TOR NAME 4
<br /> /` i- 44jpp1:c.gbi - V 6 g;,,A.w..S (.L. c- '► Site uding location ` /j/J Q,
<br /> AGENT ADDRESS V V CONTRACTOR ADDRESS of II/se i / ' J
<br /> N sio.k. IS cl`I 49 /p 0
<br /> (City,State,Zip) (City,Slate,Tap) �, C ` Setbacks 65/7 D �D
<br /> jn.,.fu , o�
<br /> PHONE PHONE ' OSite Plan approval from
<br /> S-1.v — s5-1 7 - 053 applicable township. /-
<br /> E-MAILADDRESS E-MAIL ADDRESS ,
<br /> or( Floor plans to scale
<br /> PROPERTY,LOCATION INFORMATION (http:':accessdane.co.dano.wi.us)
<br /> PARENT PARCEL ,/ ! Z ACREAGE: Elevation of property
<br /> o PARCEL Q I V..c7//-�73 4 /3-5 A C E� 3 71 ontage drawn to scale.
<br /> (�>+l-�Ar ( c\I L. sECTt i/e �1q N - %'A: SO Driveway per .• ,
<br /> �� ^/'�•' (state,coun 4 town
<br /> ADDRESS:
<br /> A79l S•tMtr RtA1 Q.,4'i. Ca.✓„ W/ s3sz7 /�
<br /> CSM: LOT SUBDIVISION -BLOCKILOT %`'�Sanita ,.-- 16,,:.. ...
<br /> /d. P . .A. N A. N A (public
<br /> PROPOSED PROJECT INFORMATION
<br /> eyi I
<br /> PROJECT DESCRIPTION: rr <r a ` a ss
<br /> Nola t v.4J .k , 7,1--aJ ,11,..4 i-,47 h.�.Inc. .{.41N. -� 1--� r t r n � �(
<br /> 17141`.°4''°'4'.14 ; r., :, �?
<br /> • MITThis project is a new building or structure. a '
<br /> This project is an addition/alteration to an existing building or structure. O G�
<br /> SANITARY SERVICE: /. '-
<br /> J Nuc--q ' PERMIT NUM : i r" _ '
<br /> WER 1. y , " ' Sa '
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) 5,
<br /> eJ-:?5'11.3. A 1 as 6.•K. / a
<br /> AREA TO NEAREST SQUARE FOOT: ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '* ; ,
<br /> BASEMENT: 1ST FLOOR: .t _)
<br /> i—,�, d0['j X � . L +TOTAL SQUARE FOOTAGE: j :"4::::',.i r" _O/
<br /> 2ND FLOOR: 3RD FLOOR: /t sa Fl x ,,^
<br /> f J tf
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -1 ♦ ♦ $ Cp,,G_� �' '�
<br /> (Please round to nearest dollar) �P , , -.. '„•;g . .. `.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ao ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? QYes no ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? E]Yes o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Etislo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a lloocation`survey requird? (see reverse)i�N3..OtA),3.n es,, .qu4t.c.h.. Elves j'.41 o ['Don't know
<br /> 7. Is this to}co t a O'atiort'� IJYes o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -∎ -►
<br /> 545-112(4109)
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