|
.SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER.INFORMATION '.-; . .,'','"'.1= -1...11.--4..1'14,;,.x _,., .'-` '•' `"J CUSTOMER TO PROVIDE
<br /> OWNER NAME t �-- ��� �nn
<br /> OAN f L- .JHNE" /-/A(,/ ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (N/u 277, 1)reef, ty,State,Zip) �,j t_ Deed Restriction;CSM
<br /> 7`7 `� 13 eft(I-L Jr1- /1 401.56A)) 14:9 / Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS •Y
<br /> (( '.3 ti ( , -g�fa/ 'an arie t r4Q v ," ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION.;. CONTRACTOR;INFORMATION . . , and includes dimensions
<br /> AGENT NAME CO T/2ACTOR NAME f
<br /> , ; Al f341L.M ',' GA Z& 0 S ❑ Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 1$755' HWY /V lit/
<br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks
<br /> /ZlC/d1,A,J0 CLi-1 W1. 3S11
<br /> PHONE - ❑ Site Plan approval from
<br /> PHONE (Ps)536_3-91 applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS n Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION :(httpa/accessdane.co.danewi.usn ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: �j / CURRENT ZONING: 16, ACREAGE: / frontage drawn t0 scale.
<br /> ❑ PARCEL OLg/ale I0--Ogz.-6�t�S dESIoBNr�AL 0 r yJ
<br /> NUMBER
<br /> TOWNSHIP: SECTION: ' ' El permits
<br /> Du^�N 08 NW �' S (state,county,town)
<br /> ADDRESS: VI/VS' BEALE . 7. AtAO/Sart. 4'2 637//
<br /> 7 / 1 ❑ Sanitary permits
<br /> CSM: LOT �_ SUBDIVISION BLOC yT/S, (public,private)
<br /> PROPOSED PROJECT INFORMATION - . ..1
<br /> PROJECT DESCRIPTION:
<br /> �'-STa4ACrE SI/E0 t ��ppy. « -, «„ :
<br /> XI This project is a new building or structure. o- l A'ii.tea 1 1
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: :4°;; ), d fls Ol
<br /> ❑SEWER ❑SEPTIC -
<br /> HEIGHT IN FEET: //yG NUMBER OF STORIES: (Not including basement) 1,.::,,,k V 9
<br /> &si OA/ fi� t.4 -,fF4 '� fJ
<br /> l�•.i eel jour r ,:it: ti A
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Lai -,i,°3 ;1S.i,,7 i p(0,.1,1,,j16:11,_
<br /> BASEMENT / 1ST FLOOR:
<br /> /V A AZ X +4--1an e1 11 (a t :' ' a, TOTAL SQUARE FOOTAGE: 4,
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> N/ ^,/A A 2'/O /1 1 f 5 4 ^Y, °+ 1 ^, r -,::10'''-i.-1?. .,-
<br /> ESTIMATED CONSTRUCTION COST -+► --► --► _ip. --► -► $ L/ 0 0a �i�t iNoilr: . t3rtit'-"A
<br /> (Please round to nearest dollar) 7 ,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? . Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Ni 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 gNo /99 7
<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 5No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes J4No
<br /> I e
<br /> 0 0 APPLICATION MUST BE SIGNED
<br /> M �(� (Continue on Back) --► —. —0.645.119 ■
<br /> rarnat
<br />
|