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1- -E E T:_ .;" - ,., " 1
<br /> ZONING PERMIT APPLICATION www.countyofdane.com ,.,._._._.__ .w. .._: .-y,.. 3.
<br /> .pRO. PEY,OWNERINF ATON i ` r;3z _ ?r 7' -_ >,- ': CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Om ©AtIT
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) f n Zoning Status; CUP;
<br /> ,/ e Deed Restriction; CSM
<br /> `)15'1 Ex*sy l- c e,, V,uf����: U — )� Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> n Site Plan drawn to scale
<br /> 4.0.ENTIINFORMATIONi, - ,ti rg;CGNTR ACTORINFORI1:010N -z -.ys „- and includes dimensions
<br /> AGENT'DAME CONTRACTOR NAME
<br /> ' IT lS Gr -i +0441p S(), — n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> i 05c j SlAc-111 F .'
<br /> (City,State,Zip) _ (City,State,Zip) El Setbacks
<br /> 1GCIC.5',f+1., —
<br /> PHONE PHONE ❑Site Plan approval from
<br /> 6m -. 0s - applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS - -
<br /> ('c, cs44,0,j-ca��nd .con, n Floor plans to scale
<br /> PROPERTY/LOCATION_INFORMAT ION> .(http//accessdane.co, ane• .us/)4.4 -, Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: Li
<br /> ElPARCEL ( IN--1 `l14_40WCl frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: ) - SECTION:
<br /> N1CII 1 ,t-Or '/a: 1/4/4; ❑Driveway permits
<br /> ) � (state, county,town)
<br /> ADDRESS: 1.'"6"/ CV n� 1ki 1"- j .3
<br /> ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public private)
<br /> PROPOSED PROJECT-INFORMATION ,7:;:;-:-_::::::"
<br /> _. . r-k- ST F� R i � _
<br /> PROJECT DESCRIPTION: ,�� C•,, a. W �t p -
<br /> D'oxlS� V( 4 1 l c LOh 1 X 6 Paic, Sic1 C �'16ice ° M.� °,�1 sc ;,
<br /> 0 This project is a new building or•structure. �" 4 9
<br /> p J 9 to rrjl red s ,
<br /> 111-T-tlis project is an addition/alteration to an existing building or structure. ' j
<br /> SANITARY SERVICE PERMIT NUMBER: t T5 - o a "S$ t
<br /> a�
<br /> EWER EPTIC of. e '�
<br /> ,, -�
<br /> HEIGHT IN FEET �� NUMBER OF STORIES; (Not including basement) �� ��� �5-
<br /> r e) o f o c 0 0 4e Itt " V S
<br /> AREA TO NEAREST SQUARE FOOT,.
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 4 '° `"�
<br /> BASEMENT 1ST FLOOR: D-)AS er� ee� �-
<br /> 4, TOTAL SQUARE FOOTAGE 4, 1CJ � ,1
<br /> 2ND FLOOR: 3RD FLOOR: � `• ; * r-03----
<br /> ,-' '__ c 7-45.-W,
<br /> -,
<br /> ESTIMATED CONSTRUCTION COST: o Q e r_ "�
<br /> (Please round to nearest dollar) "♦ ''♦ "'� ♦ -+ $ I� -. , = ' -4•
<br /> •
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? []Yes ' 1ElN6 - '['Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? []Yes ENo .EDon't know .
<br /> 3. Have you talked with the township about your project and are they in agreement'? 2 es EINo. . .
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies [r 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) res EINo . ©r o't know
<br /> 7. Is this to correct a violation? - QYes gm, .
<br /> •
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —t.-112(4/DB) -
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