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ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> (76:7-C_�S�1-E'S f)7, 2 C('y �, ,,e`,1 S/ &'z7 Zoning Status; CUP; C"
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> I '02 y6 - D A ,1 ,L /0_4 /1'74D,.) - L -c Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> '6 Y7 K- • N Site Plan drawn to scale TOIC.---Yr,��
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 2-�. 7'
<br /> AGENT NAME CONTRACTOR NAME ll
<br /> Sr I ,n G 4(Crke7 S I j"„S s/}• n A Site Plan including location tOde
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 100 c,/ 1106 / / /� >r )
<br /> (City,State,Zip) <s ") (City,State,Zip) X Setbacks /`', Z.3 ( 3/ a//
<br /> 2 1
<br /> cc-h L4-,-L4-,-J c(.—ç4 k-,4,5.
<br /> PHONE PHONE OSite Plan approval from/VA,
<br /> 6 osr 6 V 2- a 6� applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> /
<br /> A S i ti/r+( C )0._ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http J/accessdane.co.dane.wi.us/) /1 /
<br /> I�-PARENT PARCEL q/ CURRENT ZON G:� ACREAGE: Elevation of property 3/6 _f
<br /> ✓ NUMBER it le)0- /(r��� frontage drawn to scale.
<br /> TO NSHIP: SECTION;/ ,�(
<br /> l'.- ✓f '. 0,S '/4: S'�- '/4'/4:Ste' X Driveway permit
<br /> ADDRESS: Xsanitary(state, count town
<br /> `� 7 L D 4e/t/7L �L m4-0 f Sv'v wiS permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, rivaYe
<br /> ,_ ________
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION:,�J
<br /> G1 v Lo,i,-,5 s,a ,.- / 2, S iC 7. 71X3o / N Zoning District C — ,, , ,
<br /> ❑ his project is a new building or structure. � i' Il S y Permitted Use? `/
<br /> V�a
<br /> This project is an addition/alteration to an existing building or structure. 71 1 ' j 3>
<br /> SANITARY SERVICE: PERMIT NUMBER: XRural ,• J� 212 Li)
<br /> �(' /
<br /> ❑SEWER )(SEPTIC (ne `'XIStI A
<br /> HEIGHT IN FEET: ,3 0 NUMBER OF STORIES:�(Not including basement)
<br /> - •sFloodplain/ 1
<br /> J.O NEAREST SQUARE FOOT: ,
<br /> ((1 i area, attached garages and above grade decks or porches)
<br /> BE • ooR: ErosionControl permit /(�
<br /> 1111 reel 6 ,, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, /��
<br /> -- ^�' ooR: — ::::on iii
<br /> r, `� / Survey
<br /> IA
<br /> � v
<br /> Awnings, Inc. , ♦ ♦ -* -► ♦ -► $ ? Jep v and available options.
<br /> 100wRobb 3 °m e°%. .11\„r1l 1 1 sted
<br /> Richland 1 uder.W
<br /> 1. 608-e47.2628 800-w1sICNS a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't know
<br /> 2 Fax 608.647.2020 i or near the property? +'Yes ❑No ❑Don't know
<br /> www.si gnface.dom
<br /> 3 Sign and Awning Design, p about your project and are they in agreement? ❑Yes No
<br /> manufacture Installation property p y Yes ❑No ZC'@?Q_3 1
<br /> 4 ssued for this in the past 5 years?
<br /> and Service_,
<br /> 5 -zone/CUP/variance (petition/appeal# ) (leave blank if none)
<br /> Rick Maker-Salesman
<br /> 6 Cell Phone 608-604-4835 -e reverse) ❑Yes 4 No ❑Don't know
<br /> ❑Yes ,gNo
<br /> ?/f 4c 't r
<br /> TROPHY - APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -i --r. -►
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