|
ZONING PERMIT APPLICATION wn countyofdane.com SUPPLEMENTito WebApp#•
<br /> PROPERTY;OWNER_hINFORMATION_:aN?..`,,y PRZ j 1SAYyam„ lia: %' CUSTOMER TO PROVIDE •
<br /> OWNER NAME
<br /> 'Q Zoning Status; CUP; ' 1
<br /> o apDRESS (Nu Street,city,State,Zip) - Deed Restriction; CSM
<br /> �j ��• Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> 57 S'3013 ! NI Site Plan drawn to scale
<br /> AGENTTINFOR MATIOIfE,,` ,U.gs _tire CC:0*I ACTO(_t`1NFOR I TIOiNNz #a and includes dimensions 1
<br /> AGENT NAME CONTRACTOR NAME,...., ' :1
<br /> Ir�I4�,rnPSc� /9or1) C /CM ate , // Site ' luding locatio ,L G'
<br /> AGENT_s-e- SSA ^"S-rm S\-` CO �D[�R X h ��e of -
<br /> ( scat ) (CI to (� / /Setbacks 3 d�2s70 . 0
<br /> )c ll-la AM S-3 SC/ C 4, 1 Wa' ss
<br /> PHONE gSite Plan approval from
<br /> �` ., 3 ���a �$�� vo - applicable township. �,o
<br /> II
<br /> EiMAILADDRE E MAILADDRESS
<br /> ,in @ --otr "S tge e 61 t4--> s'p`un E Ej Floor plans to scale
<br /> z .fit ?.� r -• �• --,cx.,,
<br /> PROPERTY/LOCATION INFORMAT(ON>_(http.%/accessolane co,dane vlr�.us/) L_, ° Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑PARCEL �+ �+ A 1_� - 1 frontage drawn to scale.
<br /> NUMBER 4�0�' �- 2113 • '�y �.�
<br /> TOWNSHIP: - SECTIO :
<br /> 1/\nTTS0 j.� ,/a. I�� ,/a,/, �(/t� AV Driveway permits^
<br /> ADDRESS: `-�U �`�� O'�p�a M"I ll� YISanitary permits rt
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ublic - 3�
<br /> '' 14 EST. (P 4 /..-Gj_
<br /> PROPOSED PROJECT INFORMATION_ `STAPI RE v t,T
<br /> PROJEC DESCRIPTION: r�" � f � ,, �'
<br /> it W D >r e k0V Lt,.f"L b 04-1 0`° °�ru pi �c _ .
<br /> ❑This project is a new building or.structure. � k �,t r 7) bJ r ►^- a fi�-
<br /> a-
<br /> 4r his project is an addition/alteration to an existing budding or structure. Add v P {'
<br /> x � .
<br /> SANITARY SERVICE: PERMIT NUMBER: ;:..1,,5 ;
<br /> ...EWER . E. PTIC �_l ,�"e , �- .
<br /> -___#.; —r•,-
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) 3�
<br /> �� . 1 t , ,._1..)3.k-oeta l!.
<br /> 1 fig @r d #a e
<br /> AREA TO NEAREST SQUARE FOOT • „ — - ¢�_'•d /�
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �� W�s`' '
<br /> BASEMENT 1ST FLOOR: �� A11 ? r•
<br /> X 2 • 1. TOTAL SQUARE FOOTAGE ,j �° ;Qr W /
<br /> 2ND FLOOR: ✓✓ U 3RD FLOOR: /�(f // 1 re ` _.: I ,
<br /> . / D`�6 / sir}' �ti T---.. -,A4.00.oy.4,4:
<br /> a,..ESTIMATED CONSTRUCTION COST ♦ -0. � u % ` - 1'R i,
<br /> (Please round to nearest dollar) /� 0 _ 3 , -d
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ' 09 o.' E1Don't•know
<br /> 2. Is there a wetland or floodplain on or near the property? • es U1/49 -❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? €1;es ❑No. _
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? In es ; ONO
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank I none)
<br /> 6. Is a location survey required? (see reverse) - Oyes gel, 0 • ❑Don't know
<br /> 7. Is this to correct a violation? Elves 4INo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -i -► -Is
<br /> 545-112(4/08)
<br />
|