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uttm ENT o tb-App c ZONING PERMIT APPLICATION www.countyofdane.con - Y
<br /> ,>p INFOA_I'NATION I �O 1 - k: �' �K -41.,6- .
<br /> ROPERTY OWNER_ - �, `��� � ��� a,��.`-����-��=vim r:�.��f� CUSTOMER TO PROVIDE
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<br /> •. 1 NAME t `(V 1 C_ ,! C 9 l{ AA • P1 Zoning Status; CUP; /(t 3
<br /> OWNE ADDRESS (Nu r,Street,City,Stale,Zip) - / / �� 3� Deed Restriction; CSM �-.
<br /> - i "t 61- CS"- -!Pf C r © � �� Variance(# . -
<br /> HHOM PHONE CELL PHONE E-MAIL ADDRESS -
<br /> ‘OW'— y8/ —ff 2 , KSite Plan drawn to scale i-
<br /> r�z' x � � Attlikl �' _� `� 4' and includes dimensions /0 V
<br /> 3AGENT�INFORMAT..IO�t�;,,_.�"w��� �.�,5;�� ,CONT�/1CTO�wINFOR�1�TION�� 3�{;
<br /> AGENT NAME CONTRACTOR NAME '
<br /> 'Site ' __• .icluding locatio
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of el/septi
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<br /> (City,State,Zip) (City,State,Zip) 10 Setbacks 63730-1/70/50
<br /> PHONE PHONE ;,Site Plan approval from A`
<br /> - applicable township. i-
<br /> E-MAILADDRESS E-MAILADDRESS -
<br /> • Al Floor plans to scale
<br /> PROPERTY/LOCATION_1041 M ti ik,(h ttpa/aecesspane.co,dane 1.usl) "3 r� /'1�,
<br /> PARENT PARCEL NUMBER: _ CURREN/T�ONIING ACREAGE: /�J Elevation of property
<br /> PARCEL NUMBER O Oo —E 9/— ,;() , / bi.
<br /> ^� 5?, , �. frontage drawn to scale.
<br /> TOWNSHIP: ( SECTI N' ,,/ �r-
<br /> 4 G Ear-r- t —. 6 '/a: /V '/a : /._ Driveway permit
<br /> ADDRESS: (y �/ (state, County, ow.
<br /> 2 0 O 0p �. t'iJ . ) /� i t r. 9 c` j<,( .. - . ,
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<br /> CSM: LOT SUBDIVISION BLOCK/LOT ��� Sanitary permits •
<br /> • , —_ _ �_ �_ (public, private)
<br /> PROPOSED PROJECT INFORMATION ,,.:; rr'-,-'• ;:. . _- sires r ;•PR TD/E RIJP N: • / i),./4". '-. ��'�°
<br /> This project is a new building or structure. C""� E. �o P s .t- ..
<br /> El This project is an addition/alteration to an existing building or structure.
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<br /> SANITARY SERVICE: PERMIT NUMBER:
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<br /> --a EWER - EPT1C T
<br /> HEIGHT IN FEET / NUMBER OF STORIES; of including basement) _°`
<br /> 2 AREA TO NEAREST SQUARE FOOT ' S _r `� _' i
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) `vs 5,-p , e ee' z
<br /> BASEMENT r 7 D- 2.-: 1ST FLOOR:.� /U V^ ; -•CIA RE FOOTAGE: 'I o.o i s o _
<br /> 3 'f- �`
<br /> 2ND FLOOR: 3RD FLOOR ' L/�A l ��^ '�~ Y 3 F f
<br /> ••ESTIMATED CO yllriFta ' DO - t� _� F�-a E c t r �a�W.
<br /> (Please roun. . near st dollar) '♦ ♦ '♦ — r U� —" �" 4_,
<br /> 1. The prope ,ithin 300 feet o - - earn or 1000 feet from a pond or lake'? ........... ❑Yes f]No. Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No .❑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? ❑Yes .. ONO - .
<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
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<br /> 7. Is this to correct a violation? ❑Yes ❑No
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<br /> ,-•— � �J��. tjb` Z APPLICATION MUST BE SIGNED
<br /> sa�ta2{aro61 �j .'(SI 5 /J) 5-0 J (Continue on Back) —► —► —s•
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