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<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION f...,<,,,; .,;" t.1 4-_,`3, ' .,z.` 41�?A.I.l
<br /> � CUSTOMER TO PROVIDE
<br /> ClrERe,NAME a
<br /> C T,f,,�c - �` ,„e,s ►� Zoning Status;CUP; C
<br /> OWNER D�2ES 1, CA e,,Citg Sta ZiV /C 'u J C' }4,0 �r'/I gyp)
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<br /> D (/t e, l/� ` r �/ T / Deed Restriction;CSM
<br /> Variance #
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> t Site Plan drawn to scale /'`,, CO,Q
<br /> AGENT INFORMATION ,- � CONTRACTOR INFORMATION :..r : and includes dimensions 1
<br /> AGENT NAME co RACTOR NAME
<br /> 1 yc C ci i k. S LA C- % Site Plan including location P
<br /> AGENT ADDRESS CO 7012 ADD S of well/septic
<br /> 7e ' i^aj:I)r
<br /> (City,State,Zip) (Ci rate,Zip)-� ,�Setbacks q2/301 i
<br /> A C / �2Y ( a,_,/ WL
<br /> �M Site Plan approval from n/
<br /> PHONE ,H3.3:_5 -C f � 3 Qv��C applicable township: ,�/V /"!
<br /> E-MAIL ADDRESS E-MAIL ADDRESS r � / J
<br /> CO SS Ie irerS-)3i 4kce,ce j1/6 Floor plans to scale A/ a
<br /> PROPERTY/LOCATION NINFORMATION•ihttpa/accessdane:co:danewrt us ,
<br /> n ,Elevation of property
<br /> PARENT PARCEL N M ER`: URRENT ZONING: ACREAGE: p p y
<br /> PARCEL ��0,_1,� / _�����. C - 1-- -a, frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION: /�' ,r� ,�
<br /> f r f v �� '/<: ✓!� 1� '/.'/.: s c 10 Driveway permit
<br /> (state,county own
<br /> ADDRESS: .
<br /> y 00 11/1 % I (f o �� �.�
<br /> • Sa ' - permits
<br /> CSM: LOT SU I Is 1- 'T 1/4. J0 •ubf ,private)
<br /> PROPOSED PROJECT INFORMATION,
<br /> PROJECT DESCRIPTION: I galliMIIIII,-
<br /> This project is a new or 7 r
<br /> P J building (1.,
<br /> ❑This project is an addition/alteration to an existing building or structure. __SANITARY SE CE: PERMIT NUMBER: .a „,-.,
<br /> ;- �-1 i ? '
<br /> SEWER ❑SEPTIC i � i '`
<br /> HEIGHT IN FEET j LI NUMBER OF STORIES: (Not including basement) �` : ; ,-'14:� / 0/AG r
<br /> AREA TO NEAREST SQUARE FOOT: :, - ,,.
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . 1'" ,._,-...:17-,,,,, -,. �,
<br /> BASEMENT. 1ST FLOOR: VV V ��� ® �
<br /> 4, TOTAL SQUARE FOOTAGE: 4, Yt8. ,i 3
<br /> 2ND FLOOR: 3RD FLOOR: f9 7
<br /> ESTIMATED CONSTRUCTION COST: '7 !l $ �9i=s®
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ G = V ,` - �
<br /> 1. The property is within 300 feet of a stream 1000 fe ro pon r lake? ,IYes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near operty? ❑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? ❑Yes t No
<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 J4No
<br /> APPLICATION MUST BE SIGNED
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