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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> '‘-k1/4\orikt vl El Zoning Status;CUP;
<br /> OWNER ADaRESS (Number.Street City,State/AO),
<br /> Deed Restriction;CSM
<br /> 50°6 1,.;‘,AcCArk V...;* - (..)\eiti e‘ 1 \N--1.- ,)&) 1S Variance(# )
<br /> HOME PHONE CELL PHONE -ii E-MAIL ADDRESS 1,
<br /> Vit'C -et1'1,S-ttiC11 LCi,'-‘51-44155 GI', ,t, e C,Astv,vo 6 ' IACi ig]Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTACTOR NAME
<br /> e ,) ,
<br /> L:)—( "i 1 i 44-'v-vtak.t.\ El Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> CLict 3 {,...i ytticuty-st i),.‘30-,1
<br /> (City,State,Zip) (City,Stele,Zip) El Setbacks
<br /> L„,,) 1 S 3S T '
<br /> PHONE
<br /> J # 1..]Site Plan approval from
<br /> PHONE - CI S 1 - 'Li 1 SS applicable township,
<br /> —i.
<br /> E-MAIL ADDRESS ,E-MAIL ADDRESS
<br /> • Cv,sit.v.„,,A . nci Ex]Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accosodano.co.danomlust)
<br /> 0
<br /> PARENT PARCEL NUMBER CURRENT ZONING ACREAGE Elevation of property to
<br /> El PARCEL OS 0 el —Ht . t 5 ZU-- 1 L C.- I S- a „L.tt, frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP 1-..., _e. SECTION
<br /> U 1 0 VI N \AI Y.: /4 E %Y.: 1.9. T-s-PJ [3 Driveway permits
<br /> i (state,county,town)
<br /> ADDRESS
<br /> .SCCi, 3 L 1)10010
<br /> E]Sanitary permits
<br /> CSM LOT SUBDIVISION BLOCK-10T
<br /> (public,private)
<br /> '31:CAP. ! 1.,cif i I
<br /> PROPOSED PROJECT INFORMATION kiz : ,:,,,,t,:41,°4.- ),=4,4f,,.
<br /> PROJECT DESCRIPTION ,, .4k,t141:44: ,0
<br /> A t - x i
<br /> Pt NYor■,5 0,..cc- kt, 42.4:61-ihal ot.'-(---v\
<br /> ',; ' 't , tA,.=.,ii, f,' '- .-,‘ •--.,:tet!':
<br /> EJThis project is a new building or structure. - .
<br /> oThis project is an addition/alteration to an existing building or structure. .,
<br /> SANITARY SERVICE PERMIT NUMBER ;. '' '1'•i'I'I'
<br /> ,.,,...: :
<br /> ,. ..,..:::. ;1;:,,,,,
<br /> DEANER ,WEPTIC * kilt...,: .... ',-. ',-..4,,,,,,,,,,,,„n--4,,,,,,
<br /> HEIGHT IN FEET 5 c lc,. NUMBER OF STORIES (Not including basement)
<br /> ov\e„ ' .' ,-.1,“,i, „,,,,.11,1,t,,,,,,,,:,:;„,
<br /> AREA TO NEAREST SQUARE FOOT
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches)
<br /> BASEMENT 1 1ST FLOOR , .
<br /> 4, TOTAL SQUARE FOOTAGE: 1 i, ' . ''' , 'g'
<br /> 4,-
<br /> 2ND FLOOR I 3RD FLOOR I‘,,. :11,i r,'11''' -'''','
<br /> 1 (4 3 ( .c.kc-k (G.c.c ,:,, - ,I4 ,, ,:.4.
<br /> ESTIMATED CONSTRUCTION COST -s. -6. -4, -0. $ 1-1 I,,Co 0 , Ct‘ '
<br /> (Please round to nearest dollar)
<br /> ' „tidiNt.1,',;:,
<br /> r
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ...... _.. Dies IK'Jo pOon't know
<br /> 2. Is there a wetland or floodplain on or near the property? Dies platio E3Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes 1.11111No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years?............ :Yes IKNo
<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) Eves ir a Don't know
<br /> 7. Is this to correct a violation? [ales r 0
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4* —0. -4.
<br /> !',45-11;14,te)
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