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ZONING PERMIT APPLICATION wwuv.countyofdane:corn
<br /> lirsYteagiftittaidireVAiiiitle
<br /> ROPEit7;Y OWNE INFORIV1ATlaN_ .x X' -; z CUSTOMER TO O PROVIDE
<br /> OWNER NAME �~ r
<br /> /�/ `" &T~ 1 1``✓ Zoning Status; CUP; II ' 2
<br /> OWNER ADDRESS (Number,Street,City,State,Zp)
<br /> Deed Restriction; CSM Q/ ,, j c.-,71-A. -4., ,r k `
<br /> Variance(#
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> g G''//ir g r i U A .� _ _.i._. Site Plan drawn to scale
<br /> `' Z4 CONTRAC ORiIIt-FOI MATI T and includes dimensions
<br /> AGENTg`INFORMATION �_ __�-,;,: �.��__.,.._. �..._� _�_.,... ...�
<br /> 'AGENT NAME CONTRACTOR NAME
<br /> l.--i -- 61-JA� .S', /,.�/��j ���y j-��g n Site P . eluding location
<br /> AGENTADDRESS CONTRACTOJ ADDRESS J 0• e /septic L
<br /> ` - c-'7 C`r k /1 'I' "/ U
<br /> (City,State,Zip) / (City,State,Zip) [Setbacks
<br /> S 72y 11. 4�S(--
<br /> PHONE PHONE El Site Plan approval from
<br /> ; c;j-7./ - applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS .
<br /> t- e - e- 1,/,f,,,�;,/.6,.., [Floor plans to scale
<br /> :��-,�,-� - � -ter•- ,a. -
<br /> `P.ROPERTY/L0CATION INFORM ATION _(httpi//accessdane co Mane wi:usa7 __ :
<br /> PARENT PARC UMBER: CURRENT ONING: ACREAGE: . ❑Elevation of property
<br /> [PARCEL //- 2 2�/jy$ _ 2 LI frontage drawn to scale.
<br /> NUMBER / • _/
<br /> TOWNSHIP: SECTION:
<br /> 4 c ti. k, ✓k ,/4: /a/4: [Driveway permits .
<br /> (state,county,town)
<br /> ADDRESS: .J
<br /> /X / G ,-'72 /=--q C'" Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> F�,:f Y f
<br /> PROPOSED.PROJECT.INFORMATION �,~ i:r ` ___`' STAFF REVIEW ri
<br /> PROJECT DESCRIPTION: / 4-% > '4
<br /> A J U it I •' (%�,' i F - Zoning Dlstnct r .
<br /> . his project is a new building or structure. Permitfed Use? - r
<br /> ❑This project is an addition/alteration to an existing building or structure. : l "t
<br /> SANITARY SERVICE PERMIT NUMBER M® RUr▪ aI AddreSS x r-
<br /> 1---ThEWER [ TIC I y.-_ Cl/ ' C CS C N (new/existthg} ` '
<br /> HEIGHT IN FEET �� ,� NUMBER OF STORIES: (Not including basement) v r� ▪ a t t
<br /> ___ /y_G / °;® Wetland/Floodpla n%
<br /> 75Shorelandr(a"ttchment) i
<br /> AREA TO NEAREST SQUARE FOOT t~ �,r� &v
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ®l = t °l�
<br /> ErosionControi pErmlt
<br /> BASEMENT: / r• 1ST FLOOR: x A
<br /> -2 4-.jC '�v 4, TOTAL SQUARE FOOTAGE: j, slopes alsturbance
<br /> • ;ff.-$.41 6rldacaiWI-
<br /> 2N4 FLOOR 3RD FLOOR /i y sy
<br /> (/ 4/ ', iifieze
<br /> ao n
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ;rt L and avaiiabie options
<br /> (Please round to nearest dollar) �i—i;29--4"E"'' • , ,;,, ., -F,.,E --._4u'.z.. -i...
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes [ 10 [Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? [Yes No [Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? .... Efres [No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - [Yes []v o
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) .
<br /> •
<br /> 6. Is a location survey required? (see reverse) es [No [Don't know
<br /> 7. Is this to correct a violation?- [Yes 04o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —I,. --i0 -i
<br /> 545-112(4/08) - _
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