|
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App#=
<br /> PROPERTY OWNER:INFORMATION ; Y=_ ' 4 10.:',_: ,.�._; g� ;,_ " CUSTOMER TO PROVIDE S,„
<br /> -
<br /> OWNER NAM
<br /> O J..4 R - kr 1 t 1 .�,- Iex ,f-tkr-"''• c
<br /> /Zoning Status;CUP; c=d'vt
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Hui�/ Deed Restriction;CSM
<br /> 33°� c.Ti W / Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> $9 I°". am p,` ; - v `,413, O J E lYJ�,(Site Plan drawn to scale
<br /> AGENT INFORMATION. { . - CONTRACTOR INFORMATION.,; ,,, and includes dimensions
<br /> EN`T N4>.M CONTRACTOR NAME /+
<br /> rfll1)1 'pr�h.Q1L ,f recSur C.cpivw■ .14
<br /> M6, Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS
<br /> of well/septic
<br /> ptic
<br /> 'S/ 'A&Q ?59U'ALLG y VFw dN P ri
<br /> (City,State,Zi p) (City,State,Zip) Setbacks 2 .4
<br /> tJ e2or✓t4- to/. 53510 3
<br /> PHONE PHONE l.J Site Plan approval from
<br /> S 2 66R-575- &3 9. applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> °v�-'�`� Al S pf ec %erQ T JD S, ne CA Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION .;(httpa/accessdane.ao:danewLusn Elf Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZO G: ACREAGE: P P rty
<br /> PARCEL 69/D- ci 3-90001 A yd frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> lo)i jo 6c.312— -/: 1/1/: ❑ Driveway permits Nl
<br /> ADDRESS: tate,county,town)
<br /> Fv12c-STtuI
<br /> 339$ GTY kiwY ',v„ �• 53532 Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> • - �F � � •� A v � APROJECT DESCRIPTION: � ,z�� � . ,. - H
<br /> �
<br /> ik)tELL, 6 t,3 M C ° + e a a ! 'ti ?
<br /> rThis project is a new building or structure. '4 �K i'f 6 y< ¢
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: 9 `e s4 - V
<br /> PERMIT NUMBER: ,
<br /> ❑SEWER , SEPTIC C ��,�
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement n� '
<br /> AREA TO NEAREST SQUARE FOOT: r k
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 444 s 0...:',„,4.::',;-
<br /> Ry , - '
<br /> BASEMENT , 1ST FLOOR: z -sae ®" ^l� rw
<br /> 2 2 5 g 2-2-2-5 4, TOTAL SQUARE FOOTAGE: 4, s.- '''„.t: ": a k�z
<br /> rLwefteeR:D et,k-poet k aritar.1.soR:
<br /> r
<br /> ESTIMATED CONSTRUCTION COST: Ac a p y(Please round to nearest dollar) -3. -► -► —0. ♦ -► $pn ' O ,-yQ
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IA,No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes gNo ❑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? 7 ❑Yes ❑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 , No ❑Don't know
<br /> 7. Is this to correct a violation? ( ❑Yes 9610
<br /> �\,i1-'-) C°/Colj ç°A\1) APPLICATION MUST BE SIGNED
<br /> (Continue on Back) — ' —► —►
<br /> 545-112(4/08) 1J‘
<br />
|