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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 /> TfQ4d1 tA";mel
<br /> oning Status;CUP; �`
<br /> W
<br /> ONERA RESS (Number,Street,City,State,Zip) .ZDeed Restriction; CSM Fe/
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ,ob—444-775v Pvim et',enak.Ivi.i. wa►L'Siv?.ca 1� Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME IgO
<br /> a."+zt..,6c Con,irkt frii31 E►'IGait C0/7")440-1.017 gSite P ding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of •- -
<br /> 6501c `,-brie,Lci f22.,-L G5910507•7e,•Lg R.os d.
<br /> (City,State,Zip). (City,State,Zip) ,Setbacks 3 0`2 S 0/(-d
<br /> r+.t..0..) ),,,? t.rL 53562 14-3.' )�io.7,.4- 53562-
<br /> PHONE PHONE Site Plan approval from
<br /> GO$ -$34 -1 ,0 g3�-1
<br /> 3c applicable township. fG
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> alt u ? - taittb64;14ea..J.5�a►a, - eho>�;ls(a 1 c..( fkat ••,,,�4c.,. ��� Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn U
<br /> PARENT PARCEL NUMBER: CURRENT ZONIN ACREAGE: &Elevation of property / $
<br /> PARCEL A90' /�'3�o'r,te-D K frontage drawn to scale.
<br /> NUMBER E(
<br /> Driveway SECTION �^ g/1// f to '/4: .1/4-1/4: //�-+ Driveway permit
<br /> ADDRESS: 2 , / n ��'/ Q L (state, coun
<br /> CSM: \(/ LOT SUBDIVISION BLOCK/LOT �� Sanitary •-e
<br /> 21 S 13 ACC. Dc**. foiX, (public,..,g01
<br /> PROPOSED PROJECT INFORMATION STAFF REVI
<br /> PROJECT DESCRIPTION: ..w-
<br /> Si 4c //IA; )Z G f- 4, oe,u1- 51.'7,le. F •`17 1,tifZst � fJ c , I Zoning District• i f f
<br /> This project is a new building or structure. SC--V/ 0 r g Permitted Uses
<br /> ['This project is an addition/alteration to an existing building or structure. � '
<br /> SANITARY SERVICE: PERj T MB ER O eo. 2
<br /> i JoAddresd
<br /> existing)
<br /> t EWER CiEPTIC
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) `
<br /> 3 . '. We . Flood lain/
<br /> orela E (attachment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) •
<br /> ^ENT: 1 STF�LOOR:
<br /> oslonControl permit
<br /> BASEMENT:
<br /> i.2! Ll ({ 26'6 ,j, TOTAL SQUARE FOOTAGE: ,', (slopes,disturbance, ,, ;+
<br /> N' filling/access)
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 69(p (
<br /> Review Location Survey.r
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ C l a and available options.:'s
<br /> (Please round to nearest dollar) $ C. .po a. Q
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes QNo Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Eves fNNo ®Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Rfres QNo
<br /> 4. Has there been a.zoning permit issued for this property in the past 5 years? DYes 12INo
<br /> 5. Is this project associated with a rezone/CUP/variance(petition ...-. • ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) a es alo ['Don't know
<br /> 7. Is this to correct a violation? II es No
<br /> � , oS�
<br /> jo
<br /> 5 APPLICATION MUS BE SIGNED
<br /> 545-112(aros) (Continue on Back)T ♦ -♦
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