|
SUP,PLEMENTaoWeb App:
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> .PROPERTY`OWNER_INFORMATION;- '.. ., ,. CUSTOMER TO PROVIDE
<br /> OWNS
<br /> A A fa :\oss,t
<br /> Zoning Status; CUP;
<br /> OWNER ADDRESS (Nyynber,Slreect, i �,Zip) L �
<br /> 0z e l� G4 (�-t G��� Pc,� aj: c�3 2 7i Deed Variance Restriction; CSM )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> iD y P 363-V/ 6K I re.2.4,- \ 1.p5 rl c, L.I c ‘ Oe- 0+1 Ff Site Plan drawn to scale
<br /> AGENT INFO RMATION . - -CONTRACTOR.INFORMAT,ION'¢0 and includes dimensions
<br /> ' AGENT NAME CONTRACTOR NAME
<br /> C { ei,r q u Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR AIdDRESS of well/septic
<br /> (City,State,Zip) (Ci ,ty State,Zip) PT Setbacks
<br /> i
<br /> PHONE PHONE iPite Plan approval from
<br /> applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS •
<br /> Floor plans to scale
<br /> PROPERTY/LOCATION`INFORMAT ION (htt //accessdane co dane wius Ateg F
<br /> i
<br /> PARENT PARCEL NUMBER: CU RRENT ZONING: ACREAGE: vaton of property
<br /> PARCEL frontage drawn to scale.
<br /> NUMBER C��}G? '��`L"�DD • �- t 1G2C I-{,O. Z g
<br /> TO SHIP: SECTIO :
<br /> f,i,, I c 3 %<: ,//4: Driveway permits
<br /> A DRESS: ,,�� L , I v (state,county,town)
<br /> &v4!Sc 11<ii,,`J 'U�', `cs57 fl Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION ,. - ` i STAFF'RENIEW
<br /> PROJECT DESCRIPTION: (r� //JJ (n� p '-r s "
<br /> r'4'ut1'T 5J.,�k 6f10 -...,.1/,, h i..., 1 ,-, , Zoning District /
<br /> 3
<br /> This project is a new building or structure. J r '' '�" ,t
<br /> P 1 9 t Permltfel Use?�j` ,Mr.
<br /> ❑This project is an addition/alteration to an existing building or structure. , 6` -4 . -
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUral Add1feSS At
<br /> EWER [EPTIC Cne`w/exlsting� ., J3
<br /> HEIGHT IN FEET �)0 tpV NUMBER OF STORIES: (Not including basement)
<br /> -,❑ Wetland/Floodplam/
<br /> ��5D x !Y ?� U-/y � Shoreland (attachment)
<br /> AREA TO NEAREST SQUARE FOOT r^ ��
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) F
<br /> ® EroslonCon roof permit
<br /> BASEMENT 1ST FLOOR: `•i-<�r1;ir ,djstu'rban e
<br /> 4, TOTAL SQUARE FOOTAGE: •, .4 "2 c„'rs-r+�
<br /> s'a iilling7access}
<br /> 2ND FLOOR: 3RD FLOOR 14�cb y -- x y
<br /> 1 42evlewNtatlan Survey
<br /> `-t n O (EACH/ a }. `_ o•s x� .c>rcli
<br /> ESTIMATED CONSTRUCTION COST: / '�and available options*
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 44,
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes LINo Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Wes 'lo ['['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Wfres ONo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - [Yes ra o
<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 Ilio QDon't know
<br /> 7. Is this to correct a violation? QYes L o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —►
<br /> 545-112(4108)
<br />
|