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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# '•
<br /> PROPERTY-OWNER INFORMATION d4 a�� 'i , :':'.=,==.,"==.,-..''';P;''',1;.:111.1'
<br /> OWNERNAME�""-1 " `' CUSTOMER TO PROVIDE
<br /> c_2)/0101( 6 icalci- a( )/') .
<br /> txf OWNER ADDRESS (Number,Sty et,City,State,Zip) Zoning Status;CUP; �-
<br /> -I �(�� t_cl c o ) /Z�o t `X^o(0 n Deed Restriction;CSM
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# )
<br /> TOO a3o -530'0
<br /> AGENT INFORMATION P Site Plan drawn to scale if- 3/9 /
<br /> CONTRACTOR.INFORMATION.;..;:: �: and includes dimensions (v!
<br /> AG NAME CONTRA,C,T9,R NAME
<br /> 0 171 c �d✓3 e -�/C-. < > Imo` NAME
<br /> S h f
<br /> AGENT ADDRESS (J�Site Plan includin ocati n Q�� /�
<br /> CONTRACTOR ADDRESS of well/septic ik b 1, , V// r
<br /> q_po y Pe.i e�C�r^ On . 1
<br /> (City,State,Zip) (City,State‘Zip) r
<br /> /a 7 ��/ / ► Setbacks 5 / , /L►r,_ ,
<br /> PHONE v,„11L36CI vV/ 5""1 K0 I
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<br /> PHONE - f!'' Site Plan approval from / /4-/
<br /> '1 ( r),\ DI 775 -1 a - 0 `f aD applicable township:
<br /> E-MAIL ADDRESS 1 0 E-MAIL ADDRESS
<br /> ``, She 1.4-A,„hvua c,-^c, U Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION '.(http:1/accessdane.co.danewi.usn v
<br /> PARENT PARCEL NUMBER: CURRENTjONING, ACREAGE: . U Elevation of property
<br /> PARCEL l/r' a
<br /> NUMBER frontage drawn to scale.
<br /> TOWNSHIP:
<br /> SECTION:
<br /> 5 0 c 3C� + '314 , , Drivewa its /�� A
<br /> ADDRESS: /: /• /YW / Y
<br /> (state, oun •awn)
<br /> 1� K imroc/< ( 'd / '/R£71" "
<br /> CSM: LOT SUBDIVISION / BLOCK/LOT N,_'- -e permits /J/ '
<br /> uvefii-i t Tech Cv,,o,; if •ublic •rivate) / VV
<br /> PROPOSED PROJECT INFORMATION: '
<br /> PROJECT DESCRIPT N:
<br /> �rin IL / / �• ' 4 ",
<br /> e- � n
<br /> ❑This project is a new building or structure.
<br /> k' This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: � � . r. -
<br /> PERMIT NUMBER: ii`r
<br /> U SEWER U SEPTIC 1,:37--1,4.',---.
<br /> ,, �� " .'
<br /> HEIGHT IN FEET �?
<br /> NUMBER OF STORIES: (Not including basement) S
<br /> i: "F 0 O,'-
<br /> l ,"� I.t" '
<br /> >©32
<br /> AREA TO NEAREST SQUARE FOOT: .s 0 0 1,- . ° r so.
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4, ri't 4 J, c
<br /> BASEMENT: 1ST FLOOR: � e�� �a `��7
<br /> j TOTAL SQUARE FOOTAGE: ,, ? 0 4a
<br /> 2ND FLOOR:
<br /> 3RD FLOOR: m1�F'''
<br /> tug" .< "'a'" 1
<br /> ESTIMATED CONSTRUCTION COST C boo i � -
<br /> (Please round to nearest dollar) '� '� "� ► -► -► ✓ O /� O ✓ ..d(� }
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'No U Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes CNo U Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? bYes U No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes 12i 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 2fNo 0 Don't know
<br /> 7. Is this to correct a violation? ❑Yes 131No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(4/08) (Continue on Back) -.0. --o. -+
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