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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE
<br /> OWNER NAME
<br /> 3n sc.P k �, sc. ■ U cD 7ning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) ed Restriction; CSM
<br /> lo weS4 ft„t 5+. Be_lle4,.//L, WT .S-3s e riance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> (o n$'y 51,5 (,cc 3( .1 oc8,'sc,1 vo 'r l C.1,t nd•cow, o Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> J c.r.►es wd tde tl No Oete■ Cc,ns4r,..c.4.:o n, LL L ite Plan including location
<br /> AGENT ADDRESS I I CONTRACTOR ADDRESS of well/septic
<br /> /0L( (-. C Led-, s-I-• iDy t-J• ( \,...rcGN 53,
<br /> (cily,Stat i Zip) (City,State,Zip) Setbacks
<br /> 1")..e l eu,'!!e_,_GZ S 3s—c, 5R & Ile v p'1(e_, t.,J,I S-3-5'a Q _
<br /> PH NE PHONE ❑ ite Plan proval from
<br /> Ipp0 g — S(3-1-(30 (9pv - 3-(3- ce3od ica etownship.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> V1 o(devtcon g4r c.4. T 404. (t)b/cle _ ,, :tl C, .cps,,, oor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:!/accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: evatlon of property
<br /> El PARCEL
<br /> c ba _7ZJ_O Q
<br /> zo-o I V7 ontage drawn to scale. ,
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> ON R O < .._
<br /> 2_1_ /:
<br /> 1/1/. iveway permits h�
<br /> ADDRESS: state,county,town)(/ her
<br /> ,7 0 7 9 (—re„ctt4,,,n R.„2 Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 1 U( all O public,private)
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION:
<br /> F 11
<br /> U e' o on.t— 1!'J ( 43 a. oning District
<br /> . 4 IThis project is a new building or structure. Permitted Use?
<br /> ['This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R ral ' li• - S
<br /> FIEWER SEPTIC 1 3—2z/ (v 00 C 5-0 ew existin•
<br /> HEIGHT IN FEET NUMBER 91,STORIES: (Not including basement)
<br /> 44, C..'0 etland/Floodplain/
<br /> horeland (attachment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit
<br /> BASEMENT:S. 8 1 1ST FLOOR:
<br /> �fQj 4 TOTAL SQUARE FOOTAGE: j opes,disturbance,
<br /> 2ND FLOOR: 3RD FLOOR: / Illing/access)
<br /> 88 3 2. Y `P Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ and available options.
<br /> (Please round to nearest dollar) .- . ♦ ♦ $ LD 8, ©00 r
<br /> _ ,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes MN ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? , Yes o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Elio
<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 ►4 o ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ►1 o
<br /> AD n rh/t--� APPLICATION MUST BE SIGNED
<br /> sas-nz(a/oal 1aJ (Continue on Back) -► -► —►
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