|
ZONING PERMIT APPLICATION www.countyofdane.com SUPP,LEMEyrto Wets App>#
<br /> PRO_P ERTY`OWN_ER._ 1FO. R_ A-A ION �,3 `«; s 4-i _r; a \1 .� � �r 4 q� th�t ,'{,5 CUS TOM o
<br /> TO PROVIDE
<br /> OWNER NAME
<br /> G^r'y J✓e.,el /1- n Zoning Status; CUP;
<br /> OWNER ADDRESS (Amber,Street,City,State,Zip) Deed Restriction; CSM
<br /> 53.1 /,4rIer..,'IIe 2.1).. 54-01,0-,,, r Wt--- 5-3 5-.53- variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> G0Ci 5"l3 0-731 SOO Ac1CrA& 6 l C*•� n Site Plan drawn to scale
<br /> 'j.i,4iiitltNkjkOA'ttOC:rfVF,z::;55V.:ntg rCONTItACTOR"INFORIififi ON :, ; • and includes dimensions
<br /> AGEN ME CONTRACTOR NAME
<br /> JeelYtv.y Jcnsc._ \t‘ii.4 r N<xl- be,k LL C. n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 130K .SK.,.,,.,01, Wd,..Qs bc. 131/ 6,.(7---1-1 AN
<br /> (City,State,Zip) . (City,State,Zip) ❑Setbacks
<br /> 4i i-Q— ,Vfj 5-35 3'4 rib- 1Ji S-3 c3Lr
<br /> PHONE PHONE ❑Site Plan approval from
<br /> (c o'- 7 Vr- CotOZ 6,o(‘- '7&9- G,i 0 Z • applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS -
<br /> c;-t•-k;s-3- e- Lo�r.--;i .c.k-: 04--;s- U tg,- Vv. ,.,::\. e_ ■�: ❑ Floor plans to scale
<br /> :PROPERTY/L OCATION_INFORMATION* (http,l/accessdane.co dane:vin.us/) ,; --:,- n Elevation of property
<br /> PARENT PARCEL NUMBER: .- CURRENT-ZONING: ACREAGE:
<br /> ❑PARCEL p2G iach Z3-(-9 23c -1i A — IE�c L13GiS0^ Sb, p'} frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: - SECTION:
<br /> Do r.k..:'r k 1/4: 1/41/4. ❑Driveway permits
<br /> ADDRESS: (state, county,town)•
<br /> 531-1' l4lANtr.,IIC rS. S{a,,ti�,�„r, ,ul.c. 5-3 S�$9
<br /> 1E1 Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public, private)
<br /> •
<br /> PROPOSED PROJECT_INFORMATION. F. ° . r
<br /> PROJECT DESCRIPTION: y,
<br /> Ce,,treJ ..cry�.1r '(c.,:-t., Njct:'�0� '� °e e C aIV ;,-
<br /> t� k J .IBC A„•T "s 4i, "a
<br /> ❑This project is a new building"or"structure ��ge l bed' se 4,- ,:
<br /> ql-his project is an addition/alteration to an existing building or structure. ' �- G
<br /> SANITARY SERVICE: PERMIT NUMBER: s9 e
<br /> r,, E � _ y
<br /> EWER . [EPT1C 4-.1117_- -- -,'*
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) Esi - _'rfla
<br /> AREA TO NEAREST SQUARE FOOT Bt a r.�
<br /> Outside dimensions including unfinished area, attached garages and above grade decks or porches) "Ep1
<br /> BASEMENT , 1ST FLOOR:
<br /> pp 4, TOTAL SQUARE FOOTAGE _� e e
<br /> 2ND FLOOR: 3RD FLOOR: 1 { ., s .-
<br /> ESTIMATED CONSTRUCTION COST: s ' - pal e e `
<br /> (Please round to nearest dollar) ♦ ♦ '� l 000 4 -� -4
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ' EiNo ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes RNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes IRINo_ . _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years'? ❑Yes • 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 p o EDon't know
<br /> 7. Is this to correct a violation? ❑Yes o .
<br /> •
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —. -1. —o-
<br /> 545-112{4roe) .
<br />
|