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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWtR NAME
<br /> tif
<br /> 6(3ei 4- Kaf co At r1 Z., ,q ff -1
<br /> ir. Zoning Status;CUP;
<br /> OWNER ADDRESS (Number.Street.City,State Zip)
<br /> Al i S 14i i 14-op Dy.s4... S Loi Prcort t“ uj■ s 3590 ' seed Restriction; CSM
<br /> 4 Variance(# ) i
<br /> HOME PHONE CELL PHONE IE-MAIL ADDRESS
<br /> 0 X
<br /> -,'V/-404 5 3 4,708'.-4:19' -.17.S 11 ! i<re nz-lete.ho4'mek,I'cow\ .■2' Site Plan drawn to scale
<br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME A o
<br /> ' Cu5)-ttnetrk (LA stiw. ti on 4../...C.— gSite Plan including locatio
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> oll ip Om u.AXXI Ci,A.‘ .L,L)-
<br /> (City State bp) (City,Stale,Zip) Setbacks 0,50/244 ...,,,
<br /> CWL.A5 Pia MS, ki i 5 2)r::›A i _/' ci
<br /> PHONE PHONE in' Site Plan approvai from
<br /> (J20 s-.19 Y.-,,,IW' I -pplicable township. AyA
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> LI c us ki ifiAt,j @al AsizTE a.Ni r ,ill Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:/faccessdanexo.dane,wLusi)
<br /> PARENT PARCEL NUMBER CURRENT ZONING ACREAGE Elevation of property
<br /> 0 Fn,cnEELR 09 1 t-61 r5—1.31, --0 R Ii- l cg. ,),,it) frontage drawn to scale
<br /> TOWNSHIP. SECTION
<br /> ADDRESS -S1'11-. W. S V‘i 1,4%: Id 4 Driveway perm'
<br /> . --(state,oounty 4,Z,
<br /> '
<br /> (0 ))--14ci iv 4 Va tk:ev P-ei , S 44 n P(4-4 ur-I e S 3 ' it)
<br /> 'Sanitary
<br /> CSM LOT SUBDIVISION atocic'rr
<br /> IL-1Hk I (public,
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION
<br /> t■teLoh orrke— Q r K. w 411(f- COs ri,e I) Or.l......-//wr----040ning District fe 11 /
<br /> . EgIsrfiis project is a new building or structure. Xi Permitted Use? /0 8PV
<br /> I:This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER 4e(-_ , Address 26/ 2_
<br /> nEWER FoWPTIC 1-6'c)014)- (13,- )S 0 existing)
<br /> HEIGHT IN FEET NUMBER OF STORIES (Not including basement)
<br /> . .i
<br /> CACI ;;1 1 xi, ;,..
<br /> • meta . (attachment) 4
<br /> AREA TO NEAREST SQUARE FOOT,
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches)4 ErasionControl permit
<br /> BASEMENT 1ST FLOOR. 43tiCi t ALILA10%
<br /> rr rbance
<br /> 1,141.tviti, „Imo 4,...4.14,41.44, 1 4, TOTAL SQUARE FOOTAGE 4. (slopes,_1st* , 0
<br /> filling/access)
<br /> 2ND FLOOR ..3RER. Ckt.c.Li40 I kt,41C
<br /> t Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST - 4 $ , and available options.
<br /> (Please round to nearest dollar) 10, -4. .... -4.. -to - . (i,C)1-1t')‘')
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies EiSO awl know
<br /> 2. Is there a wetland or floodplain on or near the property? QYes Fro ppon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [2Ies o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? OYes 011o
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i"none)
<br /> 6. Is a location survey required? (see reverse) OYes MK,g it2:en't know
<br /> 7. Is this to correct a violation? Dyes ra
<br /> APPUCATION MUST BE SIGNED
<br /> (Continue on Back) .4. -.. -is.
<br /> sas-112(4108)
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