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UPLEMNo Wb AP ZONING PERMIT APPLICATION www.countyofdane.com - P
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<br /> -~;ROPERT�tto NER INFORMATION ' - ` �` amAp �=-d� ��' mil' CUSTOMER TO PROVIDE
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<br /> OWNER NAME
<br /> Olt'i/e/ /,� /1� / Ng .07,E h� L(2 - I J Zoning status; C - ;
<br /> OWNER ADDRESSrciber,Street,City,State,Zip) Deed Rest . on CSM
<br /> 3 7�3 /t=es7 Z Z 9 L- 6€ 1 . li) i. _! 535-3a,: Variance(#
<br /> HOME PHONE CELL PHONE E-MAILADDRESS
<br /> 4C917. 'F'Z'S 4`Jy/ b Z7-3,26 c- e//e/.Z �,-4D,® /./ ' ' I I Site Plan�1ry�d�in to scale
<br /> .070-0101.01 MAT10nl nix CONTff efotTOOR wT iiii: r and incIuil s dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> ,1r at/,V C 'vr' n Site Plarlivtriding location
<br /> AGENTADDRESS CONTRACTOR ADDRESS of Well/s tic
<br /> boa 04/6-xga /21), - ❑ to c� ����
<br /> (City,State,Zip) . (City,State,Zip) Setbacks q
<br /> uJ.yvtiu I< E, $35-9 7
<br /> PHONE PHONE ❑Site Ply, a..4 al from
<br /> ‘eP - 5//6, 95-?0 - applic:!. : a n'' ip.
<br /> E-MAILADDRESS _ E-MAILADDRESS
<br /> r N e0,,,,:t1_,-Si/4 Q0&-iiW I Floor plans to scale
<br /> 000.0TYILOCATIONt11i4F00110AtiO ibliiit ii*essilane.coid40.40 us1) _
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: I I -ovation Of prop Y
<br /> nPARCEL 67 /�i _o9/–C,209 - frontage drawN 6 scale.
<br /> NUMBER
<br /> TOWNSHIP: - SECTION: -
<br /> 2/C ,/: W/: ❑ Drivew e its
<br /> ADDRESS:
<br /> (state, O , own)
<br /> , 723 /-a7.� r— u /r/ ���QeQ :r Al—r: s'3.f-TZ "
<br /> -CSM: LOT SUBDIVISION BLOCK/LOT n Sancta its•
<br /> (Publid��1
<br /> _PROPOSED'_PROJECT INFORMATION j 0 �� ,r;S _;O _I r ,_ k X
<br /> c/ SA AE REVIE K
<br /> PROJECT DESCRIPTION: -?`
<br /> F E
<br /> gee/ea-444 �/S76e5 //cao/ 7 OF '90 JS - 0,14 P,Atfjc r.
<br /> -..
<br /> gv4 7-F 'sl
<br /> This project is a new building or structure.
<br /> MPerr-nifedEUse-- r,` 4
<br /> / This project is an addition/alteration to an existing building or structure. i-: -- __£ - -
<br /> SANITARY SERVICE: PERMIT NUMBER: Cl. i11T `_ e 5_, ,, _
<br /> e�tr e ts�-��- ,tT s�,�_
<br /> EWER . PT1C - L - -= y =to=,1 �_,
<br /> HEIGHT IN FEET: NUMBER OF STORIES; (Not including basement) =�31 - =
<br /> .Q�, _'ett Flolr� 1
<br /> Sti lei nut aftac,, ep j
<br /> , 1
<br /> AREA TO NEAREST SQUARE FOOT s_=- t_b =�� „
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �p64] a �° ;
<br /> BASEMENT: - 1ST FLOOR: ;pli �] r� PTt ±°
<br /> 0 - 4. TOTAL SQUARE FOOTAGE: j :i 13 e_5`�S UT•a e C__, a�1 ,_
<br /> . . - n access s� `7`jai
<br /> 2ND FLOOR: 3RD FLOOR: �_ 3 -.. -
<br /> . 7. ens
<br /> ESTIMATED CONSTRUCTION COST:
<br /> (Please round to nearest dollar) ♦ '� ♦ ♦ 36OG , �__ ,�z ;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes-'
<br /> 1-r,, • ❑Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? Yes EINo .[I]Don't know -
<br /> 3. Have you talked with the township about your project and are they in agreement? Ypres ENo. • .. -. . . _
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<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? ]Yes i ❑N9 • •• , .
<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 [�l No
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<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) . —1~ -•IP -4
<br /> 545-112(4roa) .
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