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C?,%1,.... COlr.t 1TY ZONING PERMIT APPLICATION <br /> D-349_ <br /> ,-t AIImi <br /> _--: C 3 5 7 /--e," i L 7 /.....1 7:I I i r --e 3. ''Ill A-I <br /> NUMBER ROAD TOWN SEC % <br /> 4v ,' / . . <br /> LC1P BLK SUBDIVISION NAME OR C. S. M. NUMBER C.U.P. # ZONE <br /> TYPE OF IMPROVEMENT PROPOSED USE <br /> [ ] New building [ ] 001 One family bldg [ ] 013 Sery sta/garage <br /> j, Addition C ] 002 Two family bldg C ] 014 Hospitals/institutions ; <br /> [ ] Alteration C ] 003 Three/four family bldg C ] 015 Office/professional <br /> C ] Repair/replacement [ ] 004 Five/more family bldg C ] 016 Public works/utility ' r <br /> C ] Moving/relocation [ ] 006 Transient hotel/motel C ] 017 Schools/educational <br /> TYPE OF FRAME [ ] 008 Amusement/recreational [ ] 018 Stores/mercantile <br /> C ] 009 Churches/religious C ] 019 Other non-residential <br /> .5(.1 Wood frame C ] 010 Industrial bldg [ ] 020 Tanks/towers <br /> C ] Masonry (wall bearing) [ ] 011 Parking garage [N.] 021 Add/alt residential <br /> [ ] Structural steel C ] 012 Residential garage [ ] 022 Add/alt non-residential <br /> C ] Reinforced concrete PROPOSED USE (If non-residential, describe in detail) <br /> [ ] Other <br /> SEWAGE DISPOSAL <br /> [ ] Pudic , <br /> [ ] Private - <br /> Permit # <br /> DIMENSIONS OWNER <br /> Long ; Li Wide ---;, c- <br /> Stories 2, Feet F- <br /> .,•. ,,- ,1 ,o'• /,t'1 / . <br /> Total floor area <br /> CONTRACTOR f' <br /> Total lot area - = <br /> PARKING SPACES , <br /> Required The undersigned and the owner of this building agree to conform to <br /> Furnished all applicable ordinances of Dane County. <br /> , <br /> SHORELAND/FLOOD PLAIN _ . <br /> Permit # Signature of owner 'or his agent Date <br /> VARIANCE INSPECTION RECORD <br /> Permit # Front yard Right yard Left yard Rear yard <br /> DWELLING UNITS (003-004) Date By Certificate issued By <br /> 1 br <br /> Notation .., • , <br /> 2 br ", e s i _ ,f <br /> •3 br - <br /> Total - <br /> PERMIT # . ?;e-7(`-'"7 ,'(p 1( FEE ,/fle I --- VOUCHER OR:-FEC,EIPT # o4- DATE /1 d f f <br /> f '; <br /> COST OF BUILDINGp5/"�/"; v_c- Issued by/,r:' - ='�•- /' ' ` f ' <br /> / 3 _ r ti'/ tf�4 t , <br />