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<br /> ZONING PERMIT APPLICATION www.countyofdane.co111 =SUPPLEMENT#o, *013-400#
<br /> :PROPERTY`OWNER INFORMATION;, . - '_<l 1 GUST MER TO P OW3 p
<br /> OWNER NAME
<br /> Sc v7-C/ i 01 040 ing Status; CUP;
<br /> OWNER ADD ESS ( umber,Street,City,State,Zip) Deed Restriction;CSM
<br /> G3/b 2 z,,,,6',6.- A, ' ? /066,-J/t,-J 4c ,`77.57 Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> AGENT INFORMATION, `.CONTRACTOR,INFORNIATI0N;_ ;,,Y �: a 1- __ - - _
<br /> AGENT NAME CONTRACTOR NAME dO e
<br /> CZ%-t LI, b'-' y (a•aj; yicC_ 10 ,f/ j7y Gt7E Ce/t/flytic ❑Site Pla in ding ation
<br /> AGENT ADD SS CONTRACT° ADDRESS of well/s c
<br /> PP, x ,/z P V. gox 1z •
<br /> (City,State,Zip) _ (City,State,Zip) ❑Set es
<br /> h/t7 -.e W/ S.3S7 Z fr .. /f cgs Gt,I S-.�5-2 Z
<br /> PHONE PHONE
<br /> ❑Site Pla r from
<br /> (o S 77 16- '775' !l, b_B - 7 S -277V applica e
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> Na ' rv- `i Y ' ;/.t,-- u - o.,_ I ; ."4.%; ( _CC'"1 ❑Floor plans to le
<br /> ,_� K
<br /> PROPERTY/LOCATION INFORMAT ION_`(http.//accessdane codane w�. , ,, ❑Elevation of pr pe
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: .
<br /> ❑PARCEL �7 t� frontage drawn scale.
<br /> NUMBER ° --/C►9C7'7^1t �Qiid_0 2_ / i b77/
<br /> TOWNSHIP: l/ SECTION:
<br /> AD/ (C ��7y /4: //4: ❑Drivew permits
<br /> 7/‹.D`R S (state, y rfty,town)
<br /> 1 Fy Rkvr ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) l
<br /> Cd_ ALL . / C . _ t
<br /> PROPOSED PROJECT INFORMATION -- _
<br /> STAFF;RVIE_
<br /> PROJECT DESCRIPTION: .
<br /> .SING 5 j - j Ly // t,fr,� _-0 Zoning DI to
<br /> . Zaitti-7---'-a''.:q.:-,'v=i---,::84...,,i,„1..pr,-,,,4. ._±.:
<br /> E. This project is a new building or structure. 'j Y ' r�e
<br /> �� Permltfe �! e? i Z :.
<br /> This project is an addition/alteration to an existing building or structure. _ �
<br /> SANITARY SERVICE: PERMIT NUMBER: Rtaral Address -
<br /> f / new/existin
<br /> EWER SEPTIC /�-Zo�( - �O. ?� � � g)
<br /> HEIGHT IN F ., NUMBER F STORIES: (Not including base ent)
<br /> 0� � `❑ Wetland/FI dp I1�
<br /> AREA TO NEAREST SQUARE FOOT: I Shoreland; a , i
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) r
<br /> BASEMENT: 1STFLOO ® EfOS}OnCO OI pEf lt4
<br /> 4, TOTAL SQUARE FOOTAGE: j ::3r �SOpeS disturbance
<br /> s o filiiteaceess
<br /> 2ND FLOOR: • 3RD FLOOR r//�� t- -+ ^- `�
<br /> ^Z1rRe. SUrNe
<br /> y
<br /> ESTIMATED CONSTRUCTION COST: ands ons*
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ C�4" +P` • ."
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? aes ( to ['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? 11Yes Lo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ❑Yes 654\10
<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) tYes ['No ❑Don't know
<br /> 7. Is this to correct a violation? QYes t]No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —►
<br /> 545-112(4/09)
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