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ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER`.:INFORMATION ' 4 A A .: • ,-.L, ,'` ',, ; ;
<br /> Cl $TOMER TO PROVIDE
<br /> OWNER NAME
<br /> B o c a Aleti, Er-,MAT AsNME.r r Li-C. ❑ Zoning Status;`CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> Deed Restriction;CSM
<br /> 3370 EvaKC go4o , 5,..wi @,o,itrK. , c✓/ 6-3.5-9;r2 Variance(# )
<br /> 140k4E PHONE CELL PHONE E-MAIL ADDRESS
<br /> 2964-/0/2 6y5--35/2/ LEI Site Plan drawn to scale
<br /> AGENT INFORMATION:_,: .'1 CONTRACTOR;;INFORMATION Y ; and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> GE/144.D 4. .)C20 Sim, &NULE.c/Ae.+16 ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 3370 I?v,ckg- Ao#46 076.4/ 4-64e.4. _Pe,At, •
<br /> (City,State,Zip) (City,State,Zip) x Setbacks
<br /> S✓../ Atibei/F , !RJ/ 53594 Sva/ /pica I it,fi., !Ail 5-3570
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> Co?S-2V2/ 837-2/41, applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION ':(http:Uaccessdane.co.danewi.us1)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑ Elevation of property
<br /> ❑ NUMBER 07//—09/-85-0,-/ �Q"�/ ��a�ps Nor frontage drawn to scale. '
<br /> TOWNSHIP: . AI OF BR,s roL 8 '/<: Ne 1/1/: ,/i/ ❑ Driveway permits
<br /> ADDRESS: (State,county,town)
<br /> 7(S3 ConNrY ,6.Nr-',4Y /I , Sv,✓444//04 , L✓/ .53s-V0 ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> ,- —
<br /> PROPOSED PROJECT INFORMATION; ,:.;,.. .::-'4, TA
<br /> PROJECT DESCRIPTION: � / ,;"rn r � . -.
<br /> 1 / 6 ,( A O ! / o�r x F c/1sk I- 0 ita ='; ? .,
<br /> ❑This project is a new building or structure. a i , v '�'
<br /> fitt This project is an addition/alteration to an existing building or structure. r ' '
<br /> SANITARY SERVICE: PERMIT NUMBER: , �,
<br /> �q�j 1
<br /> ❑SEWER 1:°r SEPTIC � ° . r'
<br /> --
<br /> HEIGHT IN FEET: ) NUMBER OF STORIES: (Not including basement) " = :I::: - � ,�
<br /> s'• t ,,I-/R- t� ®7r` ,.`:®i • `
<br /> AREA TO NEAREST SQUARE FOOT
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> /�I V BASEMENT 1 ST FLOOR: J d C
<br /> Z37 sQ,Fr �4, TOTAL SQUARE FOOTAGE: 4 ,4„t�
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> Z37 SQ Fr a �I �
<br /> ESTIMATED CONSTRUCTION COST: ♦ -► -► ♦ .-, (f; . c ® xg' i p , 1
<br /> (Please round to nearest dollar) S/ Sic , ,x
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes XNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes XI No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? $Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Iallo
<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) BYes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? [Yes ❑No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► -i
<br /> 545-112(4/08)
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