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ZONING PERMIT APPLICATION wwiw.countyofdane.com suPiPLEMENT#oWebApp#
<br /> ;PROPERTY.OWNER:INFORMATION `. `:'_Y' P:,; '- '."
<br /> --, _ ..:::-,�. ,. :. ,.. ,..: 'O H CE•USE..ONLY_?,
<br /> OWNER NAME
<br /> s
<br /> ;J '2," C.- , 1.�R. ON •12 /zoAing Distract
<br /> OW •ADD ESS (Number,Street,City,State, i•
<br /> ��q __��]- �� S M V .�[� l �3 rJ • 0 ermltted:'.Use?, x
<br /> •H e s �� E-MAILADDRESS tt , ❑ Zoning Sta
<br /> ,� •Vi P.�hcsm���eS Pho-�a+g�) Cerh � CUP
<br /> AGENT':INFORMATION ,-' `,i , ', ;;5:= ;CONTRACTOR;`,.1NFORMATIONN It r�:,�*" Deed stnctlon CSM
<br /> A.x\--I — 1 u�� Ar� CONTRACTOR NA` ��` � ' ,1( arlancer(# •:,'•,,):,,,:,
<br /> AGENT ADDRESS �1 CONTRACTOR\j`443
<br /> ADDRESS SI.. P)an,CiraV�rn,tO SCaIe
<br /> t�°l� � o 1 mc r pi Dot DA.(les 1-'n n'd includes dimensions
<br />' (City,State,Zip) (City,State,Zip)
<br /> U j�brsn . �Jl 5S%9 �7rtu r1‘ Wl 5�J�J �5�1 Ste Plan including location
<br /> , v '_` _`'_-` P•LONE . ry
<br /> S1� a0_,1,-_- 0 0 IDCEc> si 3 ' ,),,, f well/septic
<br /> E-MAILADDRESS -M AILADDRESS Setbacks.;;
<br /> `PROPERTY/LOCATION INB ORMATION AhttoN/aacessdlane co:daewi:us/) ;'' ' Si Plana oval from
<br /> PARENT `1 ^ f j ACREAGE ' pl' e"township
<br /> c-) PARCEL NUMBER_ . ,1(�--p)(P1—gf('1C); C '{ �Y\f
<br /> TOWNSHIP: f,�l t SECTION: , `Y
<br /> ! lt�t�f� V' 1/a: N V�7 1/a1/a: U') Ix ew °xistl a) '
<br /> ADDRESS: i ( t �`
<br /> `''I Jr IV D1m A/1 Oct V �� G T�r� t W 5S 7'1J li or0plans to scae°
<br /> CSM: LOT rc, Q T'' SUBDIVISION BLOCK/LOT 'r * ¢ '' '
<br /> �© LP ' C—� ievation.`of property
<br /> PROPOSED;PROJECT INFORMATION, � . frontage drawn to scale.
<br /> PROJECT DESCRIPTION: f\
<br /> Ai ,1b�i�lAt�,.,lte '''D‘' :rn(10� eD _roc 3' 1>.Ettcs WI s S ��arlVew errnffis
<br /> tia This project is a new building or structure. (staff , ounty,town)
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> Or Sanitarys rnits
<br /> SANITARY SERVICE: PERMIT NUMBER: (fLlbl 1 priyate4rr ,._
<br /> gi SEWER ❑SEPTIC �''
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 30 Wetlapd/ O 1plalrt/
<br /> t'Lt I Sh' re n`d (attachment)`
<br /> AREA TO NEAREST SQUARE FOOT: l ` x"
<br /> (Outside dimensions including unfinished area, attached gar es and above grade decks or porches)
<br /> C] EroslonCon 1 permit
<br /> BASEMENT: 1ST FLOOR: Ia,33 p/t1 TOTAL SQUARE FOOTAGE (S�OPeS st,rbance,
<br /> 4.
<br /> QU �' flit,;: cdk6.8 r"�"
<br /> ,
<br /> 3RD FLOOR:
<br /> 2ND FLOOR: l�� dO U'Re r o r. \
<br /> _ ( O.Rel - .L.Q'c nSurve V
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ _� ♦ ♦ -► and aVal ,te OptfonS
<br /> (Please round to nearest dollar) �U�� (� �xu "�' �'' `
<br /> l
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know
<br /> 2. There is a wetland or floodplain on or near the property? ❑Yes Cd.No ❑Don't know
<br /> 3. Have you talked with the township about your project? ®Yes ❑NO
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No
<br /> 5. This project is associated with.a rezone/CUP/variance (petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? ❑Yes CNo ❑Don't know
<br /> 7. Is this orrecting a violation? . ❑Yes allo
<br /> /� S APPLICATION MUST BE SIGNED
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