|
4SUPPLEMENT to Web•App#.;
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY.OWNEILINFORMAT.ION�i , =' ,'1,:66 ; ..a ,-r�,� ;.:-1,`. I `.?1--.k- CUSTOMER TO PROVIDE
<br /> NER NAME ) —i-
<br /> ____ t
<br /> ° ,�-C " '1 tc j��' ^��- I P Zoning Status;CUP;
<br /> OWNER AD ESSf I
<br /> (Number,Stet,City),Stac ziP) Deed Restriction;CSM
<br /> i f y e b 1, G ' tip 19 v -e_ C le J e )4-of 7 9)/J Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> r• Site Plan drawn to scale
<br /> AGENT INFORMATION..- `;;? CONTRACTORJNFORMATION r i.,.; ' .: t:, , and includes dimensions 1 •j' 1
<br /> AGENT NAME COyrRACTOR NAME •& r C .- 4- c f 4' i.. S �14 C�- a Site Plan including location ( A-
<br /> AGENT ADDRESS CO CTOR ADD s of well/septic
<br /> r v` �' rQj:Djr
<br /> (City,State,Zip) (Ci tate,zip)-, / �!�-. ,�Setbacks 7 3 z/
<br /> 1
<br /> PHONE P335_560 s „E �{ Q OR Site Plan approval from n /�
<br /> ✓3v ),)? applicabletownship: ,�V !T
<br /> E-MAIL ADDRESS E-MAIL ADDRESS (( //
<br /> T 4 S.S i e yc�,� 4 kee,co , Floor plans to scale A
<br /> PROPERTY/LOCATION
<br /> :INFORMATION:. http:lacc e ssdane co danew:
<br /> usn
<br /> PARENT • ' VElevation of property URRENT ZONING ACREAGE: c❑ PARCEL f � ©��V
<br /> NUMBER ( C t� C. " frontage drawn to scale.
<br /> le.
<br /> TOWNSHIP: f SECTION:
<br /> v Gci 1/: v r. /1/: r
<br /> I=N Driveway permit Ai
<br /> /� ,t (state,county own
<br /> ADDRESS:3 / j go I' I 1 I ' �0 �' E G & Gk. - /
<br /> �'I v Sa permits /1// /
<br /> CSM: LOT SU I Isy�N = -- -T ,ubl' ,private) /1/7/
<br /> CSM:
<br /> VS 4/O
<br /> PROPOSED PROJECT INFORMATION •5 1 r•
<br /> PROJECT DESCRIP / / € ;m y
<br /> gfThis project is a new building-orstwctura. r, ,
<br /> J
<br /> LI This project is an addition/alteration to an existing building or structure. r7 n r
<br /> P', E0 4 p.#4- x :,SANITARY SERVCE: PERMIT NUMBER: ,
<br /> 64 SEWER ❑SEPTIC /
<br /> ' a
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) jI u„ F ' V., /Oo&
<br /> �_r e(ra�- t YC`- t=ie,,-
<br /> AREA TO NEAREST SQUARE FOOT: ' Z :,Y [;,,
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ).�,4:= ,,,
<br /> BASEMENT 1STFLOOR: �6 d� �L e ��
<br /> 4• TOTAL SQUARE FOOTAGE: j . �Iaai ,C c t_ >k
<br /> Ij�'"—"��t. 1
<br /> 2ND FLOOR: 3RD FLOOR: - ,
<br /> gal a .P, iC 6 .a
<br /> �b =.
<br /> ESTIMATED CONSTRUCTION COST: $ •1 0 0 ...4.2: 1_..,x,..® ia� t
<br /> (Please round to nearest dollar) ! lJ a w, --- °--
<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 tki 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 LI Don't know
<br /> 7. Is this to correct a violation? ❑Yes , No
<br /> APPLICATION MUST BE SIGNED
<br /> {Continue on Back) —► —► —►
<br />
|