|
ZONING PERMIT APPLICATION www.countyofdane.com ;suPPLEMENr:to.Web.App#
<br /> PROPERTY OWNER.INFORMATION',,:.; i:.'.',7'..:=::, ;a;,'j .t.'�; i`;"',1'.: ,._: <":' '- f CUSTOMER TO PR VIDE
<br /> OWNER,�(AM�tL tb��L \
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) lAv, ❑ Zoning Sta ;CUP;
<br /> ���� Deed triction;CSM
<br /> le)‘1) Mt\ A- C�io5S rt alij i �j ar' nce(# )
<br /> HOME PHONE CELL PHONE , ADDRESS `►lJ
<br /> I ' � 111, ‘ i ite Plan drawn to scale
<br /> AGENT INFORMATION . -', CONTRACTOR INFORMATION ‘.:1,'..";,;,:".i and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> L,R,0111Ji_ tES1�N5 14 C ite Plan including location
<br /> AGENT ADDRESS r� CONTRACT R ADDRESS of well/septic
<br /> 1 ' P . fox US()
<br /> (City,State,Zip) �— (City,State,Zip) etbacks
<br /> rt ARsAaL L 1J1)1 5355 CI
<br /> PHONE PHONE I ite PI approval from
<br /> J1(( 1955— 15015 p cable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS ,
<br /> ti 1 1 1 l i t '' I Floor plans to scale
<br /> PROPERTY/LOCATION:INFORMATION�.-,(http://a.ccessdane.co.dane.wi.usl)
<br /> PARENT PARCEL NUMBER: CU NT o G: — «- GE: EI: ation of property
<br /> ❑ PARCEL 6 p 1' � al 2—g S 3—O x,� ^ 9 I fr''ntage drawn to scale.
<br /> NUMBER IJ b 1 J a (J V\ VV �` p(
<br /> TOWNSHIP: p SE 011,
<br /> j
<br /> S1)U l(kiStAk1 .' �_ '1 y<: !_=157.1 '/.'/4: v 11 D veway permits
<br /> ADDRESS: I tate,county,town)
<br /> G Sanitary permits •
<br /> CSM: LOT SUBDIVISION BLOCIVLOT (public,private)
<br /> PROPOSED PROJECT INFORMATION ! •? :,:, i'
<br /> PROJECT DESCRIPTION , ri
<br /> 111 SW6,LC fitimt.M \ktt).� ` C d- p t`(� , ,` r �� -
<br /> This project is a new building or structure. F t ji._f,,
<br /> ❑This project is an addition/alteration to an existing building or structure. f l,
<br /> SANITARY SERVICE: PERMIT NUMBER: i� . ,,, rr">`
<br /> ❑SEWER SEPTIC 51 5i) r 5-1 }� rut,.
<br /> HEIGHT IN FEET: NUMBS,OF STORIES: (Not includi basement) t ,
<br /> C , aII Z'u `, 1
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,-;:,,'--,,,, i0,.;
<br /> }.' Cry (I r '
<br /> BASEMENT 1ST FLOOR: f , (k51'4 I -5 1.
<br /> -) 1.4, TOTAL SQUARE FOOTAGE: 4, C ti _,:-. ---, .
<br /> 1
<br /> 2ND FLOOR: 3RD FLOOR: I TiltPfo(6Y"a.4.� )
<br /> ESTIMATED CONSTRUCTION COST: d
<br /> (Please round to nearest dollar) "� � O �� r��F ���g � "
<br /> 1
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? tJ es ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? es ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Yes Ito
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L1 No
<br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blan none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes jo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —* —0
<br /> 545-112(4/08)
<br />
|