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ZONING PERMIT APPLICATION www.countyofdane.conl SUPPLEMENT to Web•App;#
<br /> PROPERTY;OWNER'INFORMATION -, wt.; ,�,_,,l; rz- `.•_ Z 5Ty yam„_; fi ;{;- P-3` CUSTOMER TO PROVIDE
<br /> OWNE ME
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<br /> 't.-`c`i. k 2 ewM-ey fd n Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> q 5'G Z 12, 51,:.- RD. 0,-;54.-- vL.,T 537(b)" Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _
<br /> C,o F 239-Y1-7 n Site Plan drawn to scale
<br /> AGENT'INF ORMATIOIfi,."` � N-`.:;_ rCONTUCT,O�t"INFOR II�TION a and includes dimensions
<br /> AGENT NAME CONTRACTOR NAM
<br /> L G. C.6..-471-04-tr S n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS � of well/septic
<br /> Ion TOnc!'Li,� 114-
<br /> (city,State,Zip) - (City,State,Zip) ❑Setbacks
<br /> ,A40/),p-bo.,.- wt S 77/3
<br /> PHONE PHONE ❑Site Plan approval from
<br /> Coca ? zoo -2 - applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> icsL. . 19,.tr 6).,-��(>,r;ff�S,s 4.;r., ❑ Floor plans to scale
<br /> 'PROPERTY/LOCATION INFORMATLONr`.(http,%laecessdane.c_ o,dane:vppisI) 3. ,-- -i; ❑Elevation of property
<br /> PARENT PARCEL NUMBER: • CURRENT-ZONING: ACREAGE
<br /> ❑PARCEL S o —/ ;Z-- frontage drawn to scale.
<br /> NUMBER 07/o D'Z y"a'Z3
<br /> TOWNSHIP: - ' SECTION:
<br /> m o�'1��n� �ro IA: %IA: El Driveway permits
<br /> ADDRESS: (state, county, town)
<br /> 9S-6 Z Je i.t s )-G RI .
<br /> ❑Sanitary permits
<br /> CSM: _ LOT SUBDIVISION BLOCK/LOT (public private)
<br /> PROPOSED PROJECT INFORMATION "
<br /> `-'--�5I�1"�Rf��1�l1 _-��
<br /> PROJECT DESCRIPTION: n }� : -t
<br /> (,U'- e ( CA,,,,- r /x-19-,.t1//'/ '°lC�.rll a Di r�C �`<_eh Qom..
<br /> . �.-J�c. �F"' :. -1.-7.14 jam -
<br /> ['This project is a new building or.structure. C teer`rnl,ed _-s vi
<br /> ❑This project is an addition/alteration to an existing building or structure. Y -�
<br /> F.
<br /> SANITARY SERVICE PERMIT NUMBER: L -,s ,.. `� e -5$ . .0 6
<br /> r �1 Wk's .
<br /> . E)EWER . [EPTIC i__....14,'
<br /> 34� e --� '_.�,_�..rere,.
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) .` `-1,d
<br /> AREA TO NEAREST SQUARE FOOT: A .� T�
<br /> sW fir- ' ° ';
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -may - R.
<br /> a' D N9 e •• ee:C
<br /> BASEMENT; 1ST FLOOR:
<br /> _�-•_." 7 � fi=r
<br /> 1 TOTAL SQUARE FOOTAGE: ,j, ,,of s _
<br /> s "
<br /> 2ND FLOOR: 3RD FLOOR c a- t� -�'
<br /> I, _: ,-•_ w
<br /> 4
<br /> ESTIMATED CONSTRUCTION COST °O :`' E P, J.
<br /> (Please round to nearest dollar) -4. '"* "♦ "♦ "♦ "� $ /4 -� S.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ' Vii.,...' ❑-Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes fa o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? EYes II P. - . _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies • it o .
<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 IN o ' ❑Don't know
<br /> 7. Is this to correct'a violation? Des !li i o
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<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —*
<br /> 545-112{4ro9) -
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