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ZONING PERMIT APPLICATION www.countyofdane.com
<br /> -_..AROPERT�Yt OWNER' 1_NFOgtM Tlana-< z�,n'-7 ' , : X. ,�. , - C U TOM E R TO P R O V I D E
<br /> OWNER NAME L •
<br /> A i iAa kdri 1VIr er,5 - ning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,S ,Zip) � / ff D ed Restriction, CSM
<br /> 7722 qre Wee - i / /j2,•ddlrton WI s-55-73 ari nce(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 4-08-s-/&-7/97 i A • ,• A _® , ,.e.OM Sit Plan drawn to scale
<br /> �" rCONT CTO INFbR� ._TI.ON c - d includes dimensions
<br /> %1GENT�)NF�QRIIYIATO�f, u;,����`< �'�'��'�'�...Y�-,"a � ��'��, . ' � ='
<br /> AGENT NAME CO TRACTOR NAME
<br /> Vhazu4 PQ,1e1 urf t VerAl) eenTrct 4.1 tte Plan including location
<br /> AGENT ADDRESS .l CONTRACTOR ADDRESS f well/septic/9,,,,, C5e7I ...... I I
<br /> (City,State,Zip) (City,y,State,Zip) Setbacks
<br /> "
<br /> fl e '4,svd/,- ki/i 5s S3<P
<br /> PHONE S' e Plan a roval from
<br /> ,,ocr-,288, y399 pp.ca township.
<br /> E-MAILADDRESS E-MAILADDRESS -
<br /> Fl or plans to scale
<br /> / / i ., ::.� /L � -Ni
<br /> .�PROP BTY0001OI0-04AA 1OMT1(I ill*cs:sana.Sli -ai:as>P TW.
<br /> levation of
<br /> propert
<br /> ro e
<br /> PARENT PARCEL NUMBER: (� � J C RRENTZ _ING:( ACREAGE )I I PARCEL -� 7, ____.. frontage drawn to ale.
<br /> NUMBER
<br /> TOWNSHIP: SECTI iA I I I Driveway rmltS
<br /> NA ' eo �� C ��4��4: V
<br /> ADDRESS: (state, ounty, town)
<br /> 77 � e_ ev\ w 0 . V ,
<br /> C I I Sanita ermits
<br /> CSM:,3 ? dr n LOT SUBDIVISION BLOCK/LOT pub , private)
<br /> 7
<br /> 'PROPOSED-PROJECT..IN FORMATION - 'r a-.r . 1 " STAF _REVIEW 3.
<br /> P C DESCRIPT/I�ON: i .,.....c__ A .s t 3 7 , � n
<br /> ____ 1.....� \ �` 1 w� �L 0.17I1g ©15r�C`'s =4.
<br /> . [✓This project is a new building or structure. �ermlffed U40ti"T:4
<br /> [1This project is an addition/alteration to an existing building or structure. . .' ,p34 f
<br /> SANITARY SERVICE: PERMIT NUMBER: ai: Ruj ewe x
<br /> EWER [ EPTIC / v a eV✓ X StI m * �. •
<br /> HEIGHT IN FEET Q NUMBER OF STORIES: (Not including basement) '.s .i$ -P
<br /> I 1 CQ Wetla 0 ;tliel "
<br /> . Itiga�a;Watta epic
<br /> AREA TO NEAREST SQUARE FOOT: -_ a :F
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) } , 4.° . E""
<br /> CQ E oslot►C-oc.oJperm►t,.
<br /> BASEMENT , 1ST FLOOR: 4, re --t - - �E-_
<br /> 1, TOTAL SQUARE FOOTAGE: 1, . -.s1>3pes � :tur aflc 1 <,. �
<br /> 2ND FLOOR: 3RD FLOOR: 1)� 0 'a e-4 n: '�4-
<br /> • l RevlearooatOrig— rcfe ' I
<br /> • �'-' tom'3 -f ',1 ' . "
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ p0 �� ''alTd aft abienpttfl1ts r
<br /> (Please round to nearest dollar) 24j " �' ". _ ,. -=
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes [/No • Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? [—Yes Flo nDon't know .
<br /> 3. Have you talked with the township about your project and are they in agreement'? 121es ❑No -
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I 'Yes []t`lp .
<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 ___Don't know
<br /> 7. Is this to correct a violation? - I Yes [i]No
<br /> , .
<br /> • ._____ -- . i ,c_ , ,---
<br /> APPLICATION MUST BE SIGNED
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<br /> 545-11 z 0/os)
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