|
ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTYOOWNERINFORMATION: z, ,r t { ,_.,i.':+ CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> /),_,,,,7(/t-`" E.T s ) 1``v PZoning Status; CUP; /� — 2
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) ���
<br /> ( �/ / Deed Restriction;CSM /�0
<br /> / e� �', �`� ? Variance(# Y
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS •
<br /> ag 7/1 °9 7/ 'e L , ❑Site Plan drawn to scale
<br /> AGENT INFORMATION, - 'CONTRACTORINFORMATION_'` s,t`s
<br /> . __ „__ and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> l `.° , �/ t /7/.A .I,:/4.-k-w) / „,,,y 7-e ❑Site P ' cluding location
<br /> "AG TADDRES CONTRACTO ADDRESS O e septic X Sp
<br /> /6- C"_ C 7 k ii -/' c.- 7
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> S 4 f4L-
<br /> PHONE , PHONE El Site Plan approval from
<br /> s7
<br /> t
<br /> j-7/ - applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> ,t�4 f- e- �af�,rr/,6.r, ❑Floor plans to scale
<br /> :0-ROPE RTY/L'OCATION INFORMATION='`(http//accessdane co,dane wI. se ': ❑Elevation of property
<br /> PARENT PARC UMBER: CURRENT OWING: ACREAGE:
<br /> El
<br /> PARCEL // / �j frontage drawn to scale.
<br /> NUMBER ® !/^ D�2_ 0 3 — Z
<br /> TOWNSHIP: SECTION:
<br /> 4 t. k, 6( '/4: 1/4%4: ❑Driveway permits
<br /> (state,county,town)
<br /> ADDRESS: -�
<br /> / ' 7 x,-'71 /.- C>.�• 4
<br /> CSM: LOT SUBDIVISION BLOCK/LOT r Sanitary permits
<br /> 3 (public,private)
<br /> PROPOSED PROJECT INFORMATION - ,. STAFF REVIEW
<br /> PROJECT DESCRIPTION: =,r i :,1,,,,-,
<br /> 4 .' ,/d 7/ s f -0 Zoning District
<br /> . 1 his project is a new building or structure. = �
<br /> -T] Permitfed Use � ,.
<br /> ❑This project is an addition/alteration to an existing building or structure. `` g7:
<br /> r ,x
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> ® RuralAddressti� r N,
<br /> [EWER R PTIC (y° :' s/6 - C c j yG (new/existing)
<br /> tx HEIGHT IN FEET // NUMBER OF STORIES: (Not including basement) S
<br /> %� y / _L Wetland/Floodplain/
<br /> , . Shoreland(attachment)
<br /> AREA TO NEAREST SQUARE FOOT
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) t -_ -
<br /> BASEMENT 1ST FLOOR: ❑ ErosionConnttrol permit -
<br /> / 7,_,) e- -7 2 /j1(LI j TOTAL SQUARE FOOTAGE: I `.- (SIOpeS dlStU Ce* _
<br /> ..: 1,. fi ju-_gracce sS);
<br /> ZNO FLOOR: (V 3RD FLOOR: / ?t,� 42riy ;Yr r
<br /> I r /�Y/ 4 �) daRevie' iLLo at�-io SUniey
<br /> ESTIMATED CONSTRUCTION COST: ' } '�� "
<br /> ♦ ♦ ♦ ,♦ ♦ ♦ d� `, (, c r and available options*
<br /> (Please round to nearest dollar) �P 3 f *- :- r'
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes j to ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? [Yes EVo ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? [r/]Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [v]Po
<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) 'es ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes [24.o
<br /> APPLICATION MUST BE SIGNED
<br /> 3 01-- (Continue on Back) -► -► -►
<br /> 545-112(4/08)
<br />
|