|
4
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web-App#
<br /> PROPERTY OWNER;.INFORMATION L'.::..,=,-,:::!, ' c30v. .�,_` ,-�_ `,-. CUSTOMER TO PROVIDE a j
<br /> OWNER NAME
<br /> SvmPIrlL Cr C6D (2 rOrt DigkZoning Status;CUP;
<br /> OWNER ADD S (Number,Street,City,State,Zip) Deed Restriction;CSM
<br /> L ES 610 777(c-cc-hi, Pa 4 k ,l Variance(# ) i
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS I �j6
<br /> X0 0- - ' 556i Site Plan drawn to scale 1 ..,
<br /> AGENT INFORMATION �: CONTRACTOR INFORMATION • ,; , and includes dimensions • WI ; 1-
<br /> AGENT NAME r(. CON CTOR NAME
<br /> ` j rG r�'C r`/0 OS e _L-4 C Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR AD RESS f well/septic
<br /> (City,State,Zip) (City,State, ip) ,Setbacks i?2 1 ti "ti
<br /> G0 SQ 0, Lc.)( S.'141 0 I
<br /> PHONE PHON( / sjy , K Site Plan approval from
<br /> - 6�0. applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS //4/
<br /> C:h ri S t�s 1,cd ir0,A.,c hou;cr�t__Qo ?A Floor plans to scale tr
<br /> PROPERTY/LOCATION INFORMATION ' (http:llaccessdane.co4ane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property ✓
<br /> 0 PARCEL C a frontage drawn to scale. '
<br /> NUMBER
<br /> TOWN IP: SECT ON:
<br /> �;0( 50/1 'A: S Cc! ,/,/: A(14/ I Drivewa ermits i
<br /> state, o n ,town
<br /> ADDRESS: /� ( )
<br /> -2 l °0 / f hrOc K IZ� G /la c/i Sd—? /ASanitary permits i
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) ��`
<br /> .' t tO- C'p,,,p v5
<br /> PROPOSED PROJECT INFORMATION, !
<br /> PROJECT DESCRIPTION:
<br /> r e - Fa c c tic% l' ( 3 c 8 r-P--4442.01--,=-5,1. -- '- -. ,, , ,,, ;° .. t w❑This project is a new building or structure. F e /
<br /> This project is an addition/alteration to an existing building or structure. f 2'x ' *'
<br /> SANITARY SERVICE: PERMIT NUMBER: it,IrtNilayii Itr-;4 'j'
<br /> a< iax�` v
<br /> ❑SEWER ❑SEPTIC 2
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) _ = = *s a I a)CO i " i a
<br /> a I till 881� .1 d 1
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , 'si ` .. 4
<br /> BASEMENT: 1ST FLOOR: ®�: &���r -7 2
<br /> ,�, TOTAL SQUARE FOOTAGE: 4, .'}adL" i :
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> r'`Y-,,,-.:7''''.::',-, -f-,7,- ' : ''"':7°!:- .'.' A
<br /> ESTIMATED CONSTRUCTION COST. --► --► -► --► -i --► $ 00 0 0 0 -- gy m r- . r
<br /> Please round to nearest dollar) r„ :-, —
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes N No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes f '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 %No
<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 L2rNo ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes lir No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08)
<br /> (Continue on Back) -► --• -1
<br />
|