|
:SUPPLEMENT to,Web App#'�_
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY;OWNER INFORMATION ' E. ._ A,r,-s - ,,r CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> C-A q ii e 1/4--i vi 14-- /V c% t f' 1,.- ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) / Deed Restriction; CSM
<br /> 07. 7-5-15— C c i U,`e w �T ��"a,-t �t 'ix'r-. 10-1 -S3 5x7 Variance(# )
<br /> HOME,Pc0HIDIE CELL PHONE E-MAIL ADDReSS
<br /> 1 . S _ ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION -„ ,;_, CONTRACTOR INFORM TION_. _ and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> , r;. 1.1 ,1 /K//;� 4 ,.. k,.0( Y,etu Co.7,..? c— ❑Site Plan including location
<br /> AGENT ADDRESS r CONTRACTOR ADDRESS of well/septic
<br /> Vito 4 eat V' / /rC l 7 0 / /1'':4 n� (Le C�-
<br /> (City,State,Zip) (City,State,Zip) / ❑ Setbacks
<br /> ih D c gu ti �-f 5.4/5- 7 5 kt 4- ,4 /.r d 4�' 355 Y
<br /> PHONE r PHONE ❑Site Plan approval from
<br /> 7 /S _ g q,.. _ c y I 60y - 2 3 g 02 D 7 applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS •
<br /> .}TM 7f`ju 5 N^a, 1 -6-0-44-, {h ro ko,)I v ew . c e/r. ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATIONr'(http 1/accessdane co,dane.Wi us/) Li Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑PARCEL b y6/b 61f_/$,3^g'$O_6 K 2 - 5,0 frontage drawn to scale.
<br /> NUMBER J
<br /> TOWNS IP: SECTION:
<br /> P�e S rt "� i r►� �j '/a: �/ : ID Driveway permits
<br /> ADDRESS: (state, county, town)
<br /> .2 `YS'S /4' l/,-e,v 5 4 S-oK 1 11 -A%—. . 022 S 35-31
<br /> ❑Sanitary permits
<br /> CSM: LOT / SUBDIVISION BLOCK/LOT
<br /> 15'5 (public, private)
<br /> PROPOSED PROJECT.INFORMATION . ., .- STAFF"REVIEW
<br /> PROJECT DESCRIPTION: d K i
<br /> PIS r v oil 91 ffi“-� � q-onmg Dt$,trcfi }
<br /> . tr 3 r ' k +a..
<br /> •
<br /> . ❑This project is a new building or structure. 0 t'e{ rmtted Use s
<br /> 2rhis project is an addition/alteration to an existing building or structure. s' � t
<br /> SANITARY SERVICE: PERMIT NUMBER: Ci :Rir:al Addresst
<br /> }
<br /> EWER - r)EPTIC � aa{ne-10- tP9�=-�^
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) k i '
<br /> Ci Wetteat.160,pla(n/ `� °
<br /> gaitia`nd` at000§pt)
<br /> AREA TO NEAREST SQUARE FO : `_ r 1
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �t T t ;, r
<br /> ;.❑?E o51cflContr� pertTtlt
<br /> BASEMENT: 1ST FLOOR: ` e 'd 8 ;gi
<br /> ! r . ,, TOTAL SQUARE FOOTAGE I -\VM -0?'. ,
<br /> r
<br /> -
<br /> 2ND FLOOR: 3RD FLOOR: 7. S 5-
<br /> • IS r i s - ;5 I Reve1,124 ttn Sthy
<br /> ESTIMATED CONSTRUCTION COST: `r y
<br /> / 7 , f and-a � able ptrons, E �
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ i �'� g g - t,,a j
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IZes ❑No ❑Don't_know
<br /> 2. Is there a wetland or floodplain on or near the property? E.ITeS ENo .❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? .., Efres 2 o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes a()
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (Ieav lank if none)
<br /> 6. Is a location survey required? (see reverse) es ❑No ❑Don't know
<br /> 7. Is this to correct a violation? Des ©tqz"-
<br /> •
<br /> . APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —►
<br /> 545-192.(4/O8) .
<br />
|