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ZONING PERMIT APPLICATION www.countyofdane.com ;..SUPPLEMENT to Web•App#=
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<br /> PROPERTY OWNEWINFORMATION `_, Vf �_r_,na j MSWI „_AIR CUSTOMER TO PROVIDE •
<br /> OWNER NAME „'
<br /> Ve/i,)i S A' A'fr r7 Zoning Status; CUP; g '3
<br /> OWNER ADDRESS (Number,Street,City, late,Zip)
<br /> // Deed Restriction; CSM
<br /> //L/ 75 /jade � . . Variance(# )/F5-0
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> OS'a/3 797b �.iais p A , 9/ �,,, cow % Site Plan drawn to scale
<br /> .AGENT�(INFORMATIO)nl t;rs - �_ �: , 5r; t CONTRACTialA NFORIH! TIOt17W—M�, and includes dimensions ��
<br /> AGENT NAME CONTRACTOR NAME( �J
<br /> Se /0— h�r,n/S iCi Q,, Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS ! • Oi vallibef4io
<br /> (City,State,Zip) (City,State,Zip) Setbacks Li/e/
<br /> PHONE PHONE Site Plan approval from
<br /> applicable township. l
<br /> E-MAIL ADDRESS E-MAILADDRESS - •
<br /> Floor plans to scale
<br /> PROPRTYILOCATION 1_- FOJ;IIAA'1��0h1_ (httpa/acces5dane.co,dane.vin.usl y ,, . Elevation of property
<br /> PARENT PARCEL NUMBER: .- CURRENT 1 NING: ACREAGE:
<br /> ❑PARCEL , _ 3 7/ 3 rontage drawn to scale
<br /> NUMBER O6/0-0 — 92-3a-, �,
<br /> TOWNSHIP: SECTION: ��[/`��
<br /> • , 1�41�4: lc4c.,/4,_,ci K.—�J Driveway permit
<br /> n 4■l,1 /4 seu f><
<br /> ADDRESS: (state, county, )
<br /> 4Ai2 4ea // S iVcf '3v;.,7 ,l' c - gl S..'..ry permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 9 Sq ( (p bli• private)
<br /> PROPOSED PROJECT=INFORMATION. - `•��`4
<br /> PROJECT DESCRIPTION: / / 1 -%
<br /> S'�(Jr a�Q� .S.y Co �D �J(�� /(a /� S`/ Qrq L t- 4.111-'..�°Z.1-41., r3C!_n .,
<br /> V© � 2 •T .5 � 31 }
<br /> . QThis projectis a new building.or.structure. ``w-) ,i_ 0:�6l gd7s�et
<br /> [This project is an addition/alteration to an existing building or structure. PQ�f' , ‘ _ �;_=i ? '
<br /> SANITARY SERVICE: PERMIT NUMBER: . t a a re S
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<br /> . EWER - [EPTIC `' 016_ (W A---1 t' '
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) i' -1e -E•5•15-Y- d• -
<br /> - l b I. . • - I ...1.2.,- . ,1,...1,,.,1-_,C) 1,41.?-0: ,A
<br /> AREA TO NEAREST SQUARE FOOT T
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) --, t s.4;° -
<br /> BASEMENT: 1ST FLOOR: D ]er 0 f _perm
<br /> /„ • - D /) _ j, TOTAL SQUARE FOOTAGE j S 60eS °IS C eR� i 7,: I,; E
<br /> 2ND FLOOR: 3RD FLOOR: (/�� —.- ... °— * °= �
<br /> .3--'�--'�. 7L
<br /> ESTIMATED CONSTRUCTION COST . � ' � � '5 e�e "" `:
<br /> (Please round to nearest dollar) ♦ '♦ ♦ -► yo G _ j
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ' IS No - aDon't-knowSN Vvc'y
<br /> 2. Is there a wetland or floodplain on or near the property? QYes ENO QDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? [lYes ®No. _ " •
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ©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 ENO (Don't know
<br /> 7. Is this to correct a violation? Eves QNo _
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<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) •-+ -► -s
<br /> -4s-112-(4ro9) • -
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