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<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> r9ROETfOWNERINFOMTION_ �a s �'i gimi u � A • :tgi
<br /> - CUST ER TO PROVIDE
<br /> OWNER AME
<br /> S rJa' 176-04Sd
<br /> • •ADDRESS (N ber,Street,City,State,Zip) oning Status; CUP;
<br /> tf jc UA, • D/e--,--, Deed Restriction; CSM
<br /> Variance(# - )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> •AGENTIINFORMAT10111, , ` 4' x ;CONY Q"� °�"ter° , S. Plan drawn to scale
<br /> ,.,.j "-ti,., _RACTOkt INFORfIgT10N .a. and includes dimensions
<br /> AGENT NAME -CONTRA TOR NAME
<br /> C
<br /> feHO,e4 S vt r
<br /> ia , i°' - rs/ /�"'� cluding location
<br /> A(CG' CO CTO R ADDRE ole n
<br /> of well/s ptic ES20jo v� re-rev- c?C
<br /> ty,State,Zip) (city,St ate,Zip) acks
<br /> ,J7 GJz 3 5-9 3
<br /> PHONE PHONE d5 gv�- 22ov Site n oval from
<br /> 6d5 appl' township.
<br /> E-MAILADDRESS E-MAILADDRESS -
<br /> /E 7W- S-6664 OA/S7)e-vC72 0N, Gores []FJQerptans to scale
<br /> `PROPERTY/LOCATION INFORMATLON. (httpJ/accessdane dane.vlr,.us/) /
<br /> �' `? Elev n of property
<br /> PARENT PARCEL NUMBER: .- _ CURRENT ZONING: ACREAGE: p p rty
<br /> 0 PARCEL _ nta a drawn to scale.
<br /> NUMBER 9 b CS. cl-/ 5535 l 1-1 - -- 9
<br /> TOWN IP: -
<br /> SEON:
<br /> Q (O vAr� C I : /4/. ❑Dr ■ ay permits
<br /> ADDRESS: ( - •e °ty,town)
<br /> CA LI ) S v-x S-e, ( 0 a :anitary permit•
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> "--) 0 . 1 (public, private) rn
<br /> PROPOSED PROJECT INFORMATION , VA-7-77 PREVIEW
<br /> PROJECT DESCRIPTION: \ �;� -�r',, �� At=
<br /> ��7 / /7.)7)/7) AJ l - o ai$T ti r ".
<br /> ['This project is a new building or structure. -- F 11 1, : ,
<br /> � erm fled Usk?
<br /> his project is an addition/alteration to an existing building or structure. � {
<br /> SANITARY SERVICE: PERMIT N BERG '
<br /> o ral °° , - _
<br /> 0_ leW S,1s , ,� �.1
<br /> EWER EPT1C t " 3'�
<br /> HEIGHT IN FEET NUMB[\J
<br /> OF STORIES: (Not including basement) '=r 7-"`7-
<br /> V ,F1� /L-� z F.1 Wet a ° l_A'• fl/
<br /> Sf10 - d� - actae(
<br /> AREA TO NEAREST SQUARE FOOT: „;h �. :-
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �4- � gt— "'
<br /> BASEME T: . g P ) eta . pee[j►t .� .
<br /> s,., 1ST Y -� --- -,47-41.. u�,-•uV 4, TOTAL SQUARE FOOTAGE: 4, lope _UT 8t1C ; `g
<br /> 2ND FL OR: 3RD FLOOR a! `°a- - t
<br /> . - ..'6 6 • - : . . 7s-- G e_i . _,,,,,,,...„,,. ..'f-1.1-- -® Rev1eL t® Ivey 7-;4
<br /> ESTIMATED CONSTRUCTION COST: - �
<br /> (Please round to nearest dollar) ♦ "� "■ "� % rlda�i `= a
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ' No - []-Don't-kn% "
<br /> 2. Is there a wetland or floodplain on or near the property? ]Yes No .ODon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [Yes 2No No _
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? EfreS o
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) • QYeso - ['Don't know
<br /> 7. Is this to correct a violation? 0 Des 010
<br /> •
<br /> - APPLICATION MUST BE SIGNED
<br /> 54$-142 4roe (Continue on Back) -* --t. - -
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