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<br /> ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App#
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<br /> PROPERTY-OWNER;:INFORMATION', ,, _ ._ ,z:: ,'.:' w`.?r`� , ,_.._. ?,,.-'. :
<br /> = CUSTOMER TO PROVIDE
<br /> OWNER NAME nn
<br /> iGrifi C I c■ By'/,+rirrt i /21
<br /> OWNER ADDRESS (Numbe'r/,Street,City State,Zip) Zoning Status;CUP;
<br /> �7/ /,' l(&cs� �nc Deed Restriction;CSM
<br /> Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 40E-835"-75-5-y ‘01-- 3'15 7555`/ 1/,,/,e />4„...,:..,c-4 �.
<br /> ��=- Site Plan drawn to scale
<br /> AGENT INFORMATION. CONTRACTOR INFORMATION <.----:.',.:,-',.-1--... -: and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> —1e1PP Prtmrnt/ tAc,-Ich✓c k Co'Siv,, ;Crn EKSite Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS 'of well/septic
<br /> ,52 ` B Cf✓, 504 -2SYJ SCc(rc '
<br /> Rn/i Q
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<br /> (City,State,Zip) / S C, (City,State,Zip) ,57 Setbacks
<br /> �1L55 84,,s, it/-Z C-0?�1 i3k c-ic--c v,lie I j c-/L
<br /> \ PHONE PHONE e' Site PI approval from
<br /> V // 6o/- 79S ///Y (. 6o6-3-/SQ3 ‘ '�;2S- ?r23 app• able township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> J tS•^uet is l ( tJ c. .. ril, ccrv- 1.2 Floor plans to scale
<br /> PROPERTY/LOCATION;INFORMATION'::(http:1/accessdane.co.dane.wi.usn ' levation of property
<br /> PARENT PARCEL NUMBER: CURRENT pZ`O/NING: ACREAGE: p P rty
<br /> ❑ NUMBER 7 oS 1� ,2��`i r9/5 . !I►72 S-.5•19 r frontage drawn to scale.
<br /> TOWNSHIP: SECTION: a f
<br /> °rejell 5-O� 5 i✓ 1/4: fv 1/41/4: :� Dtv ,co nty,ADDRESS: ( aE� ty' )
<br /> �1�� l� �l cres� �s�c le Sani ermits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 16Igb �1—
<br /> (p c, rivate)
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<br /> PROPOSED PROJECT INFORMATION .
<br /> PROJECT DESCRIPTION: F � �, A �
<br /> reb✓,(a Cite.K/ /�'Xid ..� SC'n5�n f(T.i ¢_�. P �
<br /> ❑This project is a new building or structure. fr
<br /> This project is an addition/alteration to an existing building or structure. ''n-i
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> ❑SEWER 'SEPTIC • l. aliai-r„ :
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) an1'`,y„:
<br /> AREA TO NEAREST SQUARE FOOT Q �
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t E ::-; ,
<br /> BASEMEpIT: 1ST FLOOR: ' ��V P�
<br /> fry' 3,7`/ I g / 4, TOTAL SQUARE FOOTAGE: ,I, �� to ,
<br /> 2ND FLOOR: 3RD FLO ( ='fi, �� V
<br /> �/e / r<; °J(3'LI l -r
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<br /> ESTIMATED CONSTRUCTION ♦ — —► ► i — $ , P)4v 1 /4 766 � '® 'T z(Pleae round to nearest 1
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0-No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2INo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes gNo
<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 CZNo CI Don't know
<br /> 7. Is this to correct a violation? ❑Yes 'No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —0
<br /> 545-112(4/08)
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