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ZONING PERMIT APPLICATION www.countyofdane.colvI ;SUPPLEMENT to Web�App#=
<br /> PROPERTY:OWNERiNFORMATIONF ,-ii :`.rg;,Oi::., r : =a:: g' ,._.-N` ' 7=` CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> O14 44 h ! t 0tAS 1-stet 1 n Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> ..?E5a 3 ' z C rtir.A j?LL S «-3(taI- ' s 3E89 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL A DRESS -
<br /> F3 3 •0.? 1 1 Site Plan drawn to scale
<br /> A`G_ENT(INFORMATION1 ,-_ aY IP •-Sr;—N(CONTIaCTOIZ"INFOR_ `fill%TIO14:RWR ,:- and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> –T, Lq„,, 6'eVAch A.1/ ; 61"44 r/�, „(e1cr n Site Plan including location
<br /> AGENTADDRES Pte. 42. CONTRACTOR ADDRESS •s`,n 7),, ;(1.z.,r of well/septic
<br /> 3)5 L/'1 rl4v� s)s �yhC,
<br /> d�'� 535��0 ���• �S3S9
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> nL1.1 Nei)Kir' r-ii � 3a4'c] CJy ti Pre.,,v i`1:; (-)` S 6S 9'
<br /> PHONE PHONE ❑Site Plan approval from
<br /> .•2_3 - /b ` g Z3$ - /e,6- 2:, - applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS -
<br /> AIM ft,e-• 4•1 4, . u eir4 f ,)n,, ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFOJtMATLON>`:(http//accessdane,co,dane*.us/); :-::Vi,µ
<br /> PARENT PARCEL NUMBER: CURRENT-ZONING: ACREAGE: ❑ Elevation Of property
<br /> PARCEL frontage drawn to scale.
<br /> NUMBER O /cX..i1•0Wf/ZO £fl'3A.Dc.ro-X- - • 115
<br /> TOWNSHIP: - SECTION:
<br /> �{. ❑ Driveway permits
<br /> ADDRESS: s�{►ti I nb L /: /a/a: (state, county, town)
<br /> .2 e)z,3 Door Crll RGt. £ToL S'7)6►'1 lr 3SEl - ❑Sanitary permits
<br /> CSM: LOT SUBD ON BLOCK/LOT (public, private)
<br /> PROPOSED PROJECT INFORMATION -: , - '°t'sir>�I REWJ ;
<br /> PROJECT DESCRIPTION: 01 - -'`
<br /> ? ' x �o �D1<f etc- (el 4 v et5 +E �n ,0,:D, X'0 .
<br /> This project is a new building or structure. k �e rmlttd s t-''`- �
<br /> a>
<br /> This project is an addition/alteration to an existing building or structure. k* ;; � -
<br /> SANITARY SERVICE: PERMIT NUMBER 51I= A a>a -5- � .•
<br /> . EWER . [ EPTIC .,!. e 6-. -- *
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement)
<br /> -4', ,tom
<br /> `
<br /> - /0 '- g" . . O h-e e a >- ioal e 1 fe-1.
<br /> AREA TO NEAREST SQUARE FOOT: - ' B .} �
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .. -;,,, .
<br /> BASEMENT.' • 1ST FLOOR: - O f e s, r • e't{ - .
<br /> I TOTAL SQUARE FOOTAGE: 1 1° .E u , ' "'T
<br /> 2ND FLOOR: 3RD FLOOR: Q tLta oy�GC _ A .:
<br /> • -,
<br /> �.i a a :eta,: yam:
<br /> ESTIMATED CONSTRUCTION COST; 09 - t. o ' a � ' i
<br /> (Please round to nearest dollar) ♦ '♦ ■ ♦ '� /S� �0 • P— '", �" '-§--� '
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ' N 1o.- ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? [Yes klA o .❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 0 o.
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 01/ea ENO •
<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 ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes �No .
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► "JP-
<br /> 545-112 OMB) -
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