|
ZONING PERMIT APPLICATION www.countyofdane.com ;SUPPLEMENT=toWeb-App#::
<br /> PROPERTY OWNER INFORMATION; :;; ,; ' '4,. w?�;j�`',.,: ' ,� Q,J.- ;'t CUSTOMER TO PROVIDE
<br /> ER NAME a, ..._
<br /> OWNER AD ESS„(plumber,st et,ci Stat zip) � ��� Zoning Status;CUP; C
<br /> / f i g' b G r e ,A v ,� C le v e )4,d 1f14 9Y)) Deed Restriction;CSM
<br /> `i / Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 1,' ��
<br /> Site Plan drawn to scale
<br /> AGENT INFORMATION._-i , 2, CONTRACTOR;;INFORMATION ;:`;, i and includes dimensions
<br /> AGENT NAME CO CTOR NAME
<br /> J
<br /> �✓� ` , � � r 1 k. S 1. �^ C.- % Site Plan including location ( //mot"
<br /> AGENT ADDRESS CON I'gACiOR ADDRESS /� of well/septic
<br /> J�� fJJJ QQ//fit // 2� r` %' r-A. UY / i
<br /> (City,State,Zip) (Ci te,Zip} Setbacks �2 3D
<br /> PHONE PHONE - 0! Site Plan approval from /f
<br /> j3� j �j�D� �- �� applicable township: /T
<br /> E-MAIL ADDRESS E-MAIL C4 s_S i e lea ADDRESS //j
<br /> Cssc-)3 4 k0e,ce L Floor plans to scale a
<br /> PROPERTY/LOCATION=INFORMATION '.(http:laccessdane.co.dane.wi.usn , = = Elevation of property
<br /> PARENT PARCEL N M E URRENTZONING: ACREAGE: P P rty
<br /> PARCEL �'/O.._ � _6 06 2J C _ -�. I S frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION: , /
<br /> Q / c 0 Driveway permit it 4
<br /> Y e' v 1 a: 1AIA: -� (state,county own
<br /> ADDRESS:3 / i g o /n v1 ,11 �O t. t k ( ty
<br /> CSM: LOT > SU I ISM" T ! Sa - permits Al
<br /> gt Y A S 4 it //a 4/� ubl' ,private)
<br /> PROPOSED PROJECT INFORMATION : = , r �� ,
<br /> PROJECT DESCRIPTION:
<br /> -Z c 1 x �.I ' �( I Li/ VI I %I 'Kr� �s0,r"li rk" .,
<br /> 4 n?
<br /> This project is a new building or stair-hire, . )
<br /> ❑This project is an addition/alteration to an existing building or structure. -
<br /> d
<br /> SANITARY SE CE: PERMIT NUMBER: 4 At lgt't" 4
<br /> xi SEWER ❑SEPTIC
<br /> i///1_
<br /> (° ��'-: �, -:
<br /> HEIGHT IN FEET j 14 NUMBER OF STORIES: (Not including basement) V n /npt/,
<br /> ;yI r.1;1-a/ to ) / ti l/V V
<br /> AREA TO NEAREST SQUARE FOOT: �� (
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) (, �� t - E
<br /> BASEMENT: - 1ST FLOOR: g �����t �� nr ��-4, TOTAL SQUARE FOOTAGE: 4, - -.t y�y'�,�°t1 . ,,, 3°tt,,L-. ,
<br /> 2ND FLOOR: 3RD FLOOR: r
<br /> !1ty," y�e�y.ay 1. Z 4
<br /> ,�#'" 'n qo},r�` 4'°1'6T'°d I�uil t'� Vi e
<br /> f�^S
<br /> ESTIMATED CONSTRUCTION COST: .. d
<br /> (Please round to nearest dollar) "� "� "� "� "� �� � '
<br /> 1. The property is within 300 feet of a stream 1000 fe ro = pon. •r lake? XIYes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near operty? ❑Yes tNo ❑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 /kJ 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 0 Don't know
<br /> 7. Is this to correct a violation? ❑Yes ,No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► -0
<br /> 545-112(4ro9)
<br />
|