|
. Ve41(e /t $ ( (3
<br /> ZONING PERMIT APPLICATION www.countyofdane.com •.SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION ,;;:: ._ z= ;?: ;:laW,, , .,.::, f, CUSTOMER TO PROVIDE
<br /> OWNER NAME,
<br /> #1,I4. 6 r,zchi �/.
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) C Zoning Status;CUP;
<br /> �� ���� J 3 Deed Restriction;CSM
<br /> k ) G(or,cc 1 W) Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 60? g S /7)0 2— 11-7 3.° 8 V1? M,keDI 2.. G /C*V .)• ow) 2 ite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION ' : ;, an includes dimensions
<br /> AGENT NAM5 CONTRACTII N M
<br /> AGENT ADDRESS Q't t' IJ, h (.�'rcar'}S Site Plan including location
<br /> CONTRACTO ADDRE of well/septic
<br /> l YG'2- /Ve r a /Y°?, Nip, Pe Jw, P
<br /> (C ,State,Zip) (Ci State,Zip) j .Setbacks
<br /> 1'1o�'r' W1 S3) b M iGnr VV ! 5.. 71 , 4, .
<br /> PHONE PHONE .�I •ite Plan approval from
<br /> 6cR y 's -3o S, 5
<br /> �,0 3 yL/S-3C1.� J a plicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS )
<br /> M L e u W 1.w. h;, coy0 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION +:(http://accessdane.co.dane.wi.usi) � ,./
<br /> PARENT PARCE NUMBER: CURRENT ZONING: ACREAGE: LrJ levation of property
<br /> \_. PARCEL 2 ��//fronts a drawn to scale.
<br /> NUMBER (333r07C�-3c��-3iss-�, �- � � y� g
<br /> TOWNSH)P: SECTION:
<br /> /1/1.0(0//-t.f (0 7) 30 '/<: SE '/a'/:N d gelriveway permits
<br /> ADDRESS: (State,county,town)
<br /> ?? 61 O . 1—(A: IAA Pr y 'C'
<br /> CSM: LOT SUBDIVISION ,, BLOC Of CI anitary permits '
<br /> S Aei �a / /'� (public,private) VA ,
<br /> PROPOSED PROJECT INFORMATION. ' °�I, T -4
<br /> PROJE T I Et$]C IPTION: , L / q.1
<br /> C •n (rvr• rA .v to i . cua . C , L �� r ,,,
<br /> • ❑This project is a new bu ding or structure. )(a ., '- '
<br /> 'This project is an addition/a -ration to an existing building or structure. °ce
<br /> SANITARY SERVI E: a
<br /> PERMIT NUMBER: � � �� ' �
<br /> rAfsEWER ianPTIC (C4 VJA,i;!
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - : - r `i___,. f � ;
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g
<br /> BASEMENT: 1ST FLOOR: • 4 � fi� €
<br /> �'I yZ0 4, TOTAL SQUARE FOOTAGE 4, r . '-���? e-
<br /> a. F L �
<br /> 2ND FLOOR: .?4,- I
<br /> 3RD FLOOR: �d '
<br /> ESTIMATED CONSTRUCTION COST �, � � i'
<br /> (Please round to nearest dollar) '■ '� "■ '► 53 0 u- i � �rte`.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes :EfNo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes .8No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? `glYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IHNo
<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 ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ',No
<br /> ''.-09" <----Z APPLICATION MUST BE SIGNED
<br /> 545-112(4/08 I �J ' (Continue on Back) —► -4.( )
<br />
|