|
3 SUPPLEMENT to Web•App I
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNEJ2 NAME
<br /> /'('/.A/- T71- - t- .civv, ' h i•Vi c--4_ n Z• oning Status- UP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) //,�, Deed Res f ion; CSM
<br /> l7,0, ")0f� 0,,,),--
<br /> iN% . .,6 lXC.�,_ Variance( )
<br /> HOME PHONE CELL HONE E-MAIL ADDRESS ((� i
<br /> (pr y✓/ c4'TAyLc/�Gerk4,- 47N.�- n Site Plantdr�awrl t le�t'-'1
<br /> AGENT INFORMATION CONTRACTOR INFORMATION
<br /> 1-' and includes di sions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Lc or r r�Cel (//,7?M4 6,i') ❑ Site P cluding location
<br /> AGENT ADDRESS ( CONTRACTOR ADDRESS of wellkikptic
<br /> 41327 0 49 4..e011At nt'Q2e..14 W
<br /> (City,State,Zip) (City,,State,Zip) n �CK
<br /> S• etbs
<br /> C/
<br /> PHONE 6 PHONE 6/L , ❑ Site Zit: • al from
<br /> he!` s1 s- .5- 60 8'' g2 j `�v ,33 appli , ship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> € „� i-LT//YI�j (106,72 a7/0/1)40 Floor plans Vale
<br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.dane.wi usl) �;;
<br /> PARENT PARCEL NUMBER:NU CURRENT ZONING: ACREAGE: ❑ Elevation of pr erty
<br /> MBER ©7//_'°3Y-‘7/6 --- /2
<br /> --- --/ , 37/4, frontage dr n to scale.
<br /> TOWNSHIP: SECTION:
<br /> 725u/i: pP '/: 174'/: ❑ D• rive ay ermits
<br /> ADDRESS: (state, unty,town)
<br /> An etueferi idly C°"'-r- &a`2Q7'`' El Sanita pe its
<br /> CSM: LOT SUBDIVISI N BLOCK/LOT
<br /> (Sc' (public, • ate)
<br /> PROPOSED PROJECT INFORMATION x " Y"° °"
<br /> STAFFS E1/.1
<br /> ��r
<br /> PROJECT DESCRIPTION: � �� �2 � ;�„„c� � ��,.,, t��.��0
<br /> Z� A, �%'�-�it Gtr 3 z'e- �, � E��onmg Uin
<br /> . ©This project is a new building or structure. .,:A k 1V ;.
<br /> El This project is an addition/alteration to an existing building or structure. 'i`xj i " :;':l ., .,
<br /> SANITARY SERVICE: PERMIT NUMBER: ra '"d• S `454,
<br /> ri SEWER ASEPTIC " 4 exts
<br /> HEIGHT IN FEET NUMBER OF STOR (Not including basement) �x y
<br /> 75 etaAe�� DE r
<br /> h }aoreaa' ent)
<br /> AREA TO NEAREST SQUARE FOOT: s mss =- mil-,- p ,u
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ® .T f ..
<br /> �- ��OS107a�m i�rral,-e �= - ,
<br /> BASEMENf0 T 1ST FLOOR: "Vi.:-,`.z-+ . .
<br /> t
<br /> )V� o e e € t. 9 PI°I j TOTAL SQUARE FOOTAGE + i7.,,:1;,_
<br /> :2- • a S1 i
<br /> 10,;
<br /> 2ND FLOOR: -3RD FLOOR: c - _ ^/ Y
<br /> _
<br /> -_,_,-.--,;$
<br /> %am€ate` "'W
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ��� 441 .1,7, 3v-4,.ig ete -1g1
<br /> (Please round to nearest dollar) , r. -,, -o e
<br /> --1�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes rogtlo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lallo ❑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 [Zi No
<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) [ Yes No 1:1 Don't know
<br /> 7. Is this to correct a violation?
<br /> El jNo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► 4. -i
<br /> 545-112(4108)
<br />
|