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SUPP,LEMENT,to Web•App#•„�
<br /> ZONING PERMIT APPLICATION www.countyofdane com
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<br /> IPROPEOrtowNER"INFORMATIONr _ r;a;,K,F�_rf- Vii-r_ it ,,-, -- CU TONER TO PROVIDE
<br /> OWNER NAME
<br /> D0.V 1 J an CI �&LLC1 i a= -i t cl�rso i zo ing Status; CUP;
<br /> OWNER ADDRESS (N ber,Street,City,State,Zip)
<br /> a-`10� toed _ 5tee---k Stouci i( t-rm , i 535589 - V tctcsM
<br /> HOME PHONE CELL PHONE EIMAILADDR S (# - )
<br /> 608 8738939 608 515 L!O/ 3 54 Kej/1.' -16 Zv In o . 6o '►'" ite Plan drawn to scale
<br /> 'A`GENT(1NFORMATIO1Valy' z anOa ,C_ONT CTOiINEORT ON;- :j?' " '"E and includes ensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> l�_a fe_ D�✓1 t S n Si P n including location
<br /> AGENTADDRESS CONTRACTOR ADDRESS o ell/septic
<br /> gy a 5 ft rso n Ave_
<br /> (City,State,Zip (City,State,Zip) Setbacks
<br /> S'�Ijb-tJG h , (A) j 63SJ 3 9
<br /> PHONE ,/ PHONE n Site Pla pproval from
<br /> (Qd$ -515—L17°9 - appli le tow ip.
<br /> E-MAILADDRE S. E-MAILADDRESS -
<br /> R,rf, /f 1e9rcenL 9 rvlel. o- ['Floor nstoscale
<br /> PROPERTY/LOCATION_II!4FOJtI0.00,itatittP Uaccessdane,co,dane:vlri.us/) tpz1 x r-1 El eve tio f property
<br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE:
<br /> I I
<br /> El
<br /> NUMBER
<br /> PARCEL
<br /> O5 // , 0?f.9Jya�/ 1�H - 3 /0.2 fronts drawn to scale.
<br /> TOWNSHIP: - SECT N: ,, 11
<br /> Dun Lir L %: to E. h,1 : 0 E ❑Drive y permits
<br /> ADDRESS: LL (sty , county town)
<br /> Alva 12obeI - - S7/ , Slv+J' k �'t , Wl 5358'9 nsanita permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu •C, private)
<br /> PROPOSED PROJECT INFORMATION- - 'STA RE'1 IEW=
<br /> PROJECT DESCRIPTION:
<br /> 51\9 n (21 X y ' ) v-,..i...,,..,:...R-.,.,, ''-.' ,.., -..413-4,3 .i...3.W...=',V7'
<br /> •• ❑This project is a new building or structure. iderrr itwa l p, F y,,,,-
<br /> ['This project is an addition/al ration to an existing building or structure. } Z�� _ f
<br /> + ''� �'mss" -: -1 y--€'
<br /> SANITARY SERVICE: PERMIT NUMBER: '` 1-1J oldliesS
<br /> �\ �., :S ?
<br /> EWER _ EPTIC I -) .= ew �7 t
<br /> - 1 `t_'
<br /> HEIGHT IN FEET NUMBER OF STORIES: including basement) _
<br /> 1Q1/Vetla>3d/E!e e�lalta �
<br /> Z.-Sh$ s ° ;3ttacjr,e ) .
<br /> AREA TO NEAREST SQUARE FOOT: ' s='' b,..� �� ai{3ny 44
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) z-' � '-
<br /> BASEMEN f 1ST FLOOR: - � C�Fl p' 1 —,k,T
<br /> - ,, TOTAL SQUARE FOOTAGE: ,j tlOptes Ur 8 ICE;; .
<br /> 2ND FLOOR:R: 3RD FLOOR: � a es�
<br /> ,.,.;,:a-4.4%..y.4._-_-„2:-..... .z&
<br /> • 515 D f evieVt otationg5t ey -
<br /> ESTIMATED CONSTRUCTION COST: � �-r fil-t' a, a-
<br /> -i ,-■ -► -► -► C �'� W'5 abie ptfo�ls;,
<br /> (Please round to nearest dollar) $ �j Q^ � �� :f-:. ... ;;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ' JONo. ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes (13:1No .❑Don't know -
<br /> 3. Have you talked with the township about your project and are they in agreement'? 0Yes ❑No. - - _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EiYes ❑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 E' o ❑Don't know
<br /> 7. Is this to correct a violation? Des ' o .41 •
<br /> - APPLICATION MUST BE SIGNED
<br /> 16 © (Continue on Back) -0 -► ->
<br /> 545-112{4ros) -
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