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Y UPLEMENT^to Web pp#ZONING PERMIT APPLICATION www.countyofdane-com
<br /> PftOPERTY,OWNER=INFORMATION__ T,-;Z:: ME ri.1a a S _<4_.> CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Q l e____ , r , cL k.O k- L-/i6- [Zoning Status; CUP;
<br /> WNERADDRESS (Number, treet,City,State,Zip) - (�
<br /> 5,3,-t l Deed Restriction; CSM
<br /> �j-. ✓vo✓� / �lc��S4n Variance(# )
<br /> HOME PHONE j CELL PHONE E-MAILACDRESS -
<br /> . O, 2:797-7-2A •, 1 2.7122- AAQ�t.^L�.eP(At;•c+ecl, C Site Plan drawn to scale
<br /> A1`GEN.T3INFORMATIO4 r , ,,;;, ;CONTEwACTOR INFORiZVlI TION zt,7,,_„ ,,,e, and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> l',ry y 5�(Nto•A "1 - {Le V,,eK Le�,e\ [Site Plan including location
<br /> AGENT ADDRESS CONTRkCTORADDRESS J 94) of wellseptic
<br /> s C+ De,-.1-e,
<br /> �./ ,State,zip) (city,State,Zip) [ Setbacks
<br /> PHONE PHONE Sits Planapproval from
<br /> L PP
<br /> (0C)88 "7-4--1055 applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS -
<br /> A- 44,1e he ledzk • 4-c-,( - 60.,,E❑ Floor plans to scale
<br /> P,ROPERTY/LOCATION,INFO _ a" _ _ `` 'R'
<br /> • _ - �111AT(ONr,'(http I/accessdane.co.dane`w�.us/ja,
<br /> PARENT PARCEL NUMBER: 'CURRENT ZONING: 1 ACREAGE: Li Elevation of property
<br /> El NUMBER L W)obi;-35- gib I'i"� (p )�C } t.0 frontage drawn to scale.
<br /> TOWNSHIP: \ 'SECTION:
<br /> ,/� -TO%---,^ c5 Jot ✓-� 35-g--( %: it1 t.) 1/4%: N i� ❑ Driveway permits
<br /> ADDRESS: (state, county, town)
<br /> �'
<br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits
<br /> � (public, private)
<br /> PROPOSED PROJECT INFORM ATION = aA
<br /> ,-
<br /> PROJECT DESCRIPTION: .P � ' n���arr C� r Ra��l_. -6-0 o. � c.../Er., c E7
<br /> QThis project is a new building or structure. 1o) / 7 =
<br /> ,®This project is an addition/alteration to an existing building or structure. _. - y .. ` t
<br /> SANITARY SERVICE: PERMIT NUMBER: 'AS .. -�%7 -mss
<br /> . ■-EWER . 10-EPTIC 13 - to — 0 6 0 �j h.. ..-,] /�� +, ` . 1't
<br /> t 4'{
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '�� `"--�(.�+ '` �.i°��-''�-�-"=
<br /> . -irtor ec:e _�
<br /> AREA TO NEAREST SQUARE FOOT: _ z-..rr-# -. -'
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) � ' _ '� `
<br /> o �s y et ;.-k. --1,. ::
<br /> BASEMENT 1ST FLOOR: z ,{ 4
<br /> •• '•4 ' it I• 1 7 • 1 TOTAL SQUARE FOOTAGE: 4,2ND FLOOR: • ` 3RD FLOO � •4 =!!t_ c' ro S� z. •
<br /> , : a
<br /> • •-• J 3' " Vim" / 7)j E , --.::-.S -,::-zz`' ft
<br /> ,-_+.
<br /> ESTIMATED CO STRUCTION COST: °`fi cF. 1-..-IZ tI rSj' ti iarje J tt� Z 4 U 43 r . 4(Please round to nearest dollar) f
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? rifres alo [Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? [Yes to .Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes Io -
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? [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 2No QDon't know
<br /> 7. Is this to correct.a violation? - []Yes 5No .
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -0, -* -+.
<br /> 545-1t2{4/33) -
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