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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to.web App"#?
<br /> :PROPERTY�OWNEfl INFORMATION : - ;-.� M:,. `=s CUSTOMER TO PROVIDE
<br /> OWNER NAME jj��/p� 1
<br /> L1CV EA/ f 3 M —1 i /VI S6 Ai El Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zp) Deed Restriction; CSM
<br /> '7z-,s13 562,44- (/kc /t1 i t 71JA1 1 J/ S3362- Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRES /
<br /> 6. *-35'S 10 9; X03 -Sys-tog hi., Ia�',SM t,Pa h/,Cp'`"i ❑Site Plan drawn to scale
<br /> AGENTINFO_ RMATION„ CONTRACTOR_INFGRMATIDN,`' ;s:, . .,t,:;, and includes dimensions
<br /> .AGENT NAME ,�'',,, CONTACTOR NAME
<br /> Can►,PY44e�0A ) i'_C. AN>v Ci)Af.5iYUC46r3 ) LLC ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> x,909 G1,')l i Si7Y .4t '2s/ 609 ao duti/4' 4-q, Zs (
<br /> (City,Stale,Zip) (City,State,Zip) ❑Setbacks
<br /> /1 4 t Dt f i 7 n 4 1 1,-ii 5351 02.- /'41 p o l O , W! n S 1-
<br /> PHONE/ ll PHONE El Site Plan approval from
<br /> �pp
<br /> "0 —3 Y /O9, &ff-3ys-/ol d applicable township.
<br /> E-MAILADDRESS, / E-MAIL A DRESS , / [ •
<br /> ,L4 4 / cesi ]7 b/-at,i oh,/ e,/led- ,1CG4.> , /�(vi-�' ❑Floor plans to scale
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<br /> PROPERTYILOCATION:INFORMATION-=(littp://accessdane co lane wi usf�,�;,�,,-_- ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑PARCEL n t/ z7 frontage drawn to scale.
<br /> NUMBER D /Q�lO7y"LI�S Y� / ..-(�
<br /> TOWNSHIP: SECTION:
<br /> /If/�, 1,0t y 3/4: 3/43/4: El Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> i a�?� 5(. '/i, QIZU. /iii,o it ii I.)1 53312, ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> jo 5- mctY A z (public,private)
<br /> • ; ' • . . , • : ,, „ : . 1 • STAFF:REVIEW
<br /> PROJECT DESCRIPTION: = ti '
<br /> 64i-o DCC4C 0 Zornng D lstnct {
<br /> . ['This project is a new building or structure. Permitfed Uses
<br /> WI' his project is an addition/alteration to an existing building or structure. 4 0 k r ? r_
<br /> -`3 r _s .r
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUral Addre :i
<br /> EWER [EPTIC • `(new/exisUng� _
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) • t__ 7``
<br /> ❑ Wetand/Floodplai n/
<br /> Shoreland(attachment)
<br /> AREA TO NEAREST SQUARE FOOT _ -
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) z `° t fi rv4 r
<br /> �0 ErosionControi permit
<br /> BASEMENT 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: j sor e i—ttu c
<br /> r s fllin7acess).
<br /> 2ND FLOOR 3RD FLOOR /n'r{(/ //_ ]/' iv � -- -
<br /> hfl Rewew�L}ocation SUrvey
<br /> zr a z-� �. �. .�rv�
<br /> ESTIMATED CONSTRUCTION COST: and available options
<br /> (Please round to nearest dollar) ♦ ♦ ♦ --► ♦ -► $ /0 000 f'� ,4> ,,1:0
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ No ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes Jo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EtNo
<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
<br /> 7. Is this to correct a violation? Efres No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) ■ ■ —9
<br /> 545-112(4/08)
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