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-73 7
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME -
<br /> ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip). Deed Restriction; CSM
<br /> /,sl Wel"t 'o-W_AL4 4'Lt t... t.3-C- Ct.,“ m I°ueti /L" Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> i \j 7 70 Ll / 11/ ' e,:/ 7�Or' 1 7 L/S L3ricro•1 . t;rI L vQV,ZVI iv,f1Ils.KO Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> U Agri 6-0/Ct clu /_-iv iyy/C (ct-i (c�ci cl /'U,r-e/e s S Cl Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> eJ i
<br /> 5-Us "G. . (-70 l F �1 ,. .to--e_ n 7 �'`i E. e-ciA144 . ,Ci Je- b -E
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> 4/./IYI4/a'i tfttyf.3 /LU,c'c S f -l1'-u/on 1k0 >11-.S /L.. (4'00c"PHONE PHONE ❑ Site Plan approval from
<br /> L/ry �c3:3/0 7, 6c/ 7 '7 ( 0LSC3 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> 4btszoi (016ciz'l ii K;,rtiess (car? , rvt tdU-- ., c-c.-1core),ct wt j2/«S. 4 0 Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y
<br /> ❑ PARCEL U / U `/3 - 730 �/ C- frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: 65 W t SECTION: .
<br /> 1 1/a: L5V\J 141/a: ,'V ❑ Driveway permits
<br /> ADDRESS:
<br /> (state,county,town)
<br /> 'PC) R4OL ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> a r� . x
<br /> , _
<br /> PROJECT DESCRIPTION: a^,..C ^� tL_ 2 /./1. 16- cr-wr-u:,. t'k
<br /> fr -<k-a 0_, kut.°4... nt*16 0 A '
<br /> ❑This project is a new building or structure.
<br /> ,i . t om'i
<br /> This project is an addition/alteration to an existing building or structure. of ,
<br /> ❑1uura , .fires
<br /> SANITARY SERVICE: PERMIT NUMBER: / * �
<br /> ❑SEWER C3 SEPTIC 3(ne : .. a 5 Iw,
<br /> HEIGHT IN FEET i,_% NUMBER OF STORIES: (Not including basement)
<br /> (1 1 , e slo
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) - r, U
<br /> BASEMENT 1 ST FLOOR: ' " 'i, ,!5 , o
<br /> 4, TOTAL SQUARE FOOTAGE: 4, ' 0 , , $� L "
<br /> 2ND FLOOR: 3RD FLOOR: (� r
<br /> 4
<br /> ESTIMATED CONSTRUCTION COST: ( -, As .i az ,� ,
<br /> (Please round to nearest dollar) ♦ "i -+ -+ "♦ ♦ $ 3 :� CYJO
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ANo ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? 1:3 Yes iliNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ODYes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 4Yes ❑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 allo Cl Don't know
<br /> 7. Is this to correct a violation? ❑Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -►
<br /> 545-112(4/08)
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