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. ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT o Web-App#
<br /> PROPERTY OWNER INFORMATION ,,:.r ., _ .'>''- P ;O,,.: :: .t,_.;<_ _t,.-.-J1: - w CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> M ►Rte- -4-.6=1,1 E--q t\l -23gLi-W C -
<br /> Zoning Status;CUP;
<br /> OWAIER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> °' -C6 e'? S4-O 2. t 0 lso-3, w i 5 3 7 0 S Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 2-791 7_3 9 'z-- ASite Plan drawn to scale
<br /> AGENT INFORMATION , CONTRACTOR INFORMATION ' , , and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 6.--1-(a.1.5 (11 I!.(�' Cs s)s-r („-Lc_ (1 Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic 1`�
<br /> 31860 k/-4,)Ey P.v, � ��ii(/
<br /> (City,State.Zip) (City,State,Zip) 4Setbacks <
<br /> C c lrAe> GP-cs-./ LJ/ /��� ,c
<br /> PHONE PHONE 1 �1�\ m A
<br /> Site Plan approval fro
<br /> L.aa) g 7 7 —/3 ( e., applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS •
<br /> PA Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION .(http:llaccessdane.co.dane.wLus/) 'z ' =' ,
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property
<br /> 0 PARCEL of&/a-, i _344-5'5 4- R- 1 1 09 frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> 0.-arf4C.E G2'7-/ 31 1/: SE 1/1/: SE Z\Driveway p ermi
<br /> ADDRESS: ` (State,COUnty,�iWVnJ
<br /> 32© 1 c-
<br /> k1,,,J ) R.0,.
<br /> Sanitary p- .••s
<br /> CSM LOT SUBDIVISION BLOCK/LOT (public, 0
<br /> PROPOSED PROJECT INFORMATION, y„;4 ,,T
<br /> PROJECT DESCRIPTION: r- a�, `' 7:-'L
<br /> + t3 y ' 2
<br /> SThis project is a new building or structure. ^'2. 4 7
<br /> - a
<br /> This project is an addition/alteration to an existing building or structure. r;2:'.,,..,� '.C.,-. 11'- � - 7e.
<br /> PERMIT NUMBER:
<br /> SANITARY SERVICE: '� ' e•a 4.'
<br /> 0
<br /> .,,..
<br /> ❑SEWER SEPTIC S / g 7.,5-cc � `, Ii r` !T q c i
<br /> HEIGHT IN FEET: V NUMBER OF STORIES: (Not including basement) : ,1 ' s � i7T V 0
<br /> ` _ �
<br /> AREA TO NEAREST SQUARE FOOT: .:-`-
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t'.' S e � - 24 ° 07 0
<br /> BASEMENT: 1ST FLOOR: Z3 � e ®� a � �� =
<br /> 'Z 320 cov. S-ro.,P TOTAL SQUARE FOOTAGE: , -'ate �t `°�U , 1' ///
<br /> Dt�t�
<br /> 2ND FLOOR: 3RD FLOOR: 4..K 1040 e �t �3
<br /> S f 4 /9, ('i 4(o-
<br /> Oo a � i /47 ESTIMATED CONSTRUCTION COST: ♦ -- ♦ '- '' ♦ , 1 # 1 ..:
<br /> (Please round to nearest dollar) 3S0 ��•�� _ �
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't kno
<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? ❑Yes to
<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) J'es ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes Io
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
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