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ZONING PERMIT APPLICATION www.countyofdane.com ,SUPPLEMENT to Web�App#
<br /> PROPERTY;OWNER"INFORMATION r r YME- r - r � ._;.;_ {�, ,�fi• ± T;`: ,$T CUSTOMER TO PROVIDE
<br /> •�'Ef2NAME ^ , _ .
<br /> .�. �' \Gt - o c 4 c 6 A a #�I Zoning Status; CUP, /(C 3 a
<br /> owNE ADDRESS (Nu r,Street,city,Stale,zip) I Deed Restriction' CSM
<br /> 1 l l- Dr e s t 1:-_ ,4'c r P ill 4 .? 6 _j,S10 Variance(# � ^
<br /> HOML PHONE , PHONE E-MAIL ADDRESS
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<br /> ' yb '"%( Z, Site Plan drawn to scale r
<br /> AGENT INFORM A TION, _ _� �'' . 5r 1CONTItACTOIt INFOR;I IgT10�N 3y '`"a�? I .and includes dimensions fie
<br /> AGENT NAME CONTRACTOR NAME `_�fac.j3ns
<br /> KSite • • .•cluding locatio
<br /> AGENTADDRESS CONTRACTOR ADDRESS of el/septi
<br /> (City,State,Zip) (City,State,Zip) f Setbacks 6 3/ 'c/z1,10/So
<br /> PHONE PHONE ;'Site Plan approval from At%
<br /> applicable township. iA-
<br /> E-MAILADDRESS E-MAILADDRESS -
<br /> ,�l Floor plans to scale
<br /> PROPERTYILOCATI ON_4IN,FQRMATIONr- (http.Uaccessdane.co,dane:ws.usl)� j;,' , /Wj 'Elevation of property d
<br /> ElPARENT NUMBER O -Oi — . /y CURRENT // G. ACREAGE: 5?, ;2 5`F'frontage drawn to scale. /
<br /> TOWNSHIP: `.4 G ('a r fL SECT!QN' 1A. ,, / , s ,•f �'a Driveway permit
<br /> rJ far- L � /V� �4�4' � (state, county,
<br /> ADDRESS: 2 `� g. ..,.3-0 N h t`V , i K, I^ 7 O' "\ /
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<br /> CSM: �_ LOT SUBDIVISION BLOCK/LOT /1 S(public,nitary�/ •• S
<br /> PROPOSED PROJECT INFORMATION '`' :' STrWRa11E1 :S
<br /> PR T DE RIPS ON:
<br /> A 5 C f c 9/ 5' c —17 y x ' ,7 s, _.- _--......>. /— N t'VC 0 v ili-t-p(- i :_-, e di .ai Inv' —,----= /
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<br /> ,--z.,-,-.74 -...,-.2.This project is a new building or structure. L`'�'� i ‘5,' {Wd_ -se'f -7-• ��- '/
<br /> ❑This project is an addition/alteration to an existing building or structure. a E 2
<br /> SANITARY SERVICE: PERMIT NUMBER: / ;_` -A•Vie$ - - '
<br /> EWER EPTIC / 3 .-- �`° / (O -- O V �� �'�� St:IZ +���
<br /> HEIGHT IN FEET F NUMBER OF STORIES: t including basement) A 4, -' _.
<br /> AREA TO NEAREST SQUARE FOOT: • -°- F- - / 4,-.▪ D.1:-.,E.
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<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ids _ ' ,-= . :
<br /> A 410 op- pertzut
<br /> BASEMENT: - 1ST^F��LOC IV Q = e �
<br /> �. [- / /U FO uARE FOOTAGE: ,,, i y � e C'r'�i` ,T
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<br /> 2ND FLOOR: 3RD FLOOR: p Q n _ " �
<br /> •ESTIMATED CO 2 `' ` Q-e _
<br /> (Please roun nearest dollar) ♦ G �/� _ 1.� -=' k_' /1)74.
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<br /> . • $".97.2.• 5 0 . c-C7 0 OD PO
<br /> 1. The prope ithin 300 feet o eam or 1000 feet from a pond or lake? [Yes ONo-• fDon t-know
<br /> 2. Is there a wetland or floodplain on or near the property? QYes ENo QDon't know .
<br /> 3. Have you talked with the township about your project and are they in agreement'? DYes QNo. .• . . . _
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des 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) QYes QNo QDon't know
<br /> 7. Is this to correct.a violation? [Yes DNo
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<br /> `� �S O Li Z APPLICATION MUST BE SIGNED
<br /> 5c/.3) - 5'.0 (Continue on Back) —► --► —►
<br /> 545-112(4108) Z c; iiiTI 5, 2 (:)S
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