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ZONING_ PERMIT APPLICATION www.countyofdane.coin = UPP,LEMENT to�Web•App#
<br /> PROPERTY`OWNER° NFORMATON ,` F :W-RaV- - M A*< aA CUSTOMER TO PROVIDE
<br /> iWNE NAME /,�
<br /> C" `I /{I j"�4 7 �� Zoning Status; CUP; a
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) ..../
<br /> ,A Deed Restriction; CSM
<br /> 3V A. .�44C girs f// -�
<br /> - , 3 ',5- Y Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> &DY 6q9`-`/14)' c`/PI 1 E Site Plan drawn to scale
<br /> 'AGENT'INFORMATION1,. �_ r -. q .R..,,.�.�. �...-,va z, � �-le�
<br /> -�„�;��CO.NTI�ACTO�t 1NFOR�If�T10N���:�, � :nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> PI Site Plan including location
<br /> AGENTADDRESS CONTRACTOR ADDRESS of well/septic
<br /> (city,State,Zip) (City,State,Zip) 74_ Setbacks ,
<br /> PHONE PHONE .Site Plan approval from A,%
<br /> applicable township. ,
<br /> E-MAIL ADDRESS E-MAILADDRESS -
<br /> kr Floor plans to scale
<br /> PROPERTY/LOCATION INFORIIAAtto ";(http//aeces5iane co,dalnewpausiy,,, ”. Elevation of property V
<br /> PARENT PARcFLNUMBE CURRE TZONING ACREAGE:
<br /> ❑PARCEL 1( Iz-16 z—700— 1 frontage drawn to scale.
<br /> NUMBER O
<br /> TOWNSHIP: /�,, SEcy �( I 1 '
<br /> / �t A /p '/a: , V w '/a%a: c V ZDrivew- •-emits
<br /> ADDRESS: /O . /i ^ C 77/, (state, ou ■► , town)
<br /> CSM: (/� LOT �F SUBDIVISION BLOCK/LOT r Sanitary permits
<br /> 2:80 publicaa
<br /> PROPOSED PROJECT-INFORMATION n f ==
<br /> SI�1^I�R���I�E��� �i
<br /> PROJECT P ••N: u* s� � : .
<br /> taJ d �� �•
<br /> • [9 This project is a newbuilding.or"structure. FT ei emit >`s °X` t
<br /> This project is an addition/alteration to an existing building or structure. ;=
<br /> SANITARY SERVICE: PERMIT NUMBER: =. ,A9P z .,,
<br /> DEWER EPTIC '-4'4 ' �`ti-r. _
<br /> .r "-'-.:ice,
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement)
<br /> --7 „..---.--.1--
<br /> •:T.w- -'/ / -� �0 �7 Q CjP.o l :
<br /> _..r Q r_. 0 " ems_:
<br /> AREA TO NEAREST SQUARE FOOT A,
<br /> ((Outside dimensions including unfinished area attached garages and above grade decks or porches) � -f = " w _
<br /> 9 9. 9 9 P )� ,i-,1-:1-5.—,--,-
<br /> D as, 0 • e X30
<br /> BASEMENT , 1ST FLOOR: a '`�_'
<br /> �� O• 1 TOTAL SQUARE FOOTAGE 4 :511!;e,>,,,1:1' .
<br /> 4.2ND FLOOR:R: 3RD FLOOR T �yr
<br /> ' • / 1 2, 0 . - _-
<br /> ESTIMATED CONSTRUCTION COST -e„` E e(Please round to neare s t dollar)COST -► -► /VOV D I D -
<br /> _-_
<br /> _ _ .
<br /> ....
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes ' ONo.• ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑No .['Don't know .
<br /> 3. Have you talked with the township about your project and are they in agreement'? [ Yes ❑No. . _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes • ONO
<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 []No ❑Don't know
<br /> 7. Is this to correct a violation? [Yes ONo ”
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<br /> D /,....5 , APPLICATION MUST BE SIGNED
<br /> g S, (Continue on Back) -9 -9 -♦
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