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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT t. Web4pp
<br /> PROPERTY OWNER INFORMATION , _, _ .-;_ t. -� r-;'`• CUSTOMER TO PROVIDE
<br /> OWNER NAME `'\ .__
<br /> L_ Pak. L -C ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 1797 e-0)/,'k 5 t4-cre Lrtyt€.) Ct ' Pl("..-7s, k5L G-3-52--87 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 4%0g-75$-151 (d0'g-a1.'2-1II 02 c•bu-e-cA v-1-erZ3-A$ ❑ Site Plan drawn to scale
<br /> *GENTINFORMATION ' ,;,, ,CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME OLiYL
<br /> y � -+ PC�,�r l t,ec�--t ,r--anbu ,,,❑Site Plan including location
<br /> ,e�At3ENi-'ADB E9S" " `` CONTRACTOR ADDRESS of well/septic
<br /> ( '7 -7 9 7 go i t i'vz,5s)'ks ... `
<br /> (City,State,Zip) (city,State,Zip) ❑ Setbacks
<br /> Cirds FIC6{'�s_ L S ?J
<br /> PHONE PHONE ❑Site Plan approval from
<br /> CpB 10 _ -7 9._ )5/ g • applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> • to b u.e >2P_r -}aS r>- - ❑ Floor plans to scale
<br /> `PROPERTY/LOCATION`INFORMATION ::'(httpa/accessdane.'co,dane.wi us/) ,
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ' ACREAGE: ❑ Elevation of property
<br /> ❑rPiuMBER Og'Og-19a-8'000- 1 fi9r;ct-tkor-wil frontage drawn to scale.
<br /> TOWNSHIP: - SECTION:
<br /> ger l Yr- I e 10 '/4: 1/4.1/4.. ❑ Driveway permits
<br /> ADDRESS: (state, county, town)
<br /> `7-7cJ 7 ga))i r-1- Acres Lev-tie_,C(C)-SS P4,',-2— ;‘-`33: ,S3& 111
<br /> Sanitary permits
<br /> CSM: LOT SUBDIVISION 'BLOCK/LOT
<br /> (public, private)
<br /> PROPOSED PROJECT INFORMATION ,
<br /> - STAFI=`REVIEW
<br /> PROJECT DESCRIPTION:.yam O�.rz„ pi-n5 a-Pkjirg ',vim ,-t sec.rne Y i3 {
<br /> 1 C- l
<br /> . ['This project is a new building or structure. z0 Permitted Use '
<br /> ['This project is an addition/alteration to an existing building or structure. ` � j
<br /> , = ` ;
<br /> SANITARY SERVICE: PERMIT NUMBER: I-:© RUrra:"..1:.,,,,1,,,,A ddess,3,
<br /> 1,.(ne Istiplg)= 4. g.
<br /> EWEREPTIC �, ; : k:
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) f ��'`" j Y
<br /> Qz1/1/etland/Flot c{�lain��
<br /> °��0 _ Sho>-elattd` attachmeflt) -
<br /> AREA TO NEAREST SQUARE FOOT `t- L j s
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) :-` 4- •
<br /> BASEMENT: i 1ST FLOOR: lilECdgai -on r jpertTilt i
<br /> \ ' ,, TOTAL SQUARE FOOTAGE 1 4 S9opeS`�IIS uTbatic ;L F
<br /> 2ND FLOOR: 3RD FLOOR: , A� AVx - s
<br /> aO RevieYt�1`os_atlon SSui1ey
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► /'� � acrd a_,ab{ pt?oJ i6,,
<br /> (Please round to nearest dollar) $ 8 V lJ OU - ., _
<br /> •1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? glYes ❑No • ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Eyes No .❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ®Yes ENO . .
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eves [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) Elves No ❑Don't know
<br /> 7. Is this to correct a violation? Lives No .
<br /> •
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -t► -4 -►
<br /> 545-192{4108) .
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