|
ZONING PERMIT APPLICATION www.countyofdane.conl sUPPLEMENT#o Web App;
<br /> 'PROPERTY OWNER INFORMATION _- .' sir - N,I- CUSTOMER TO PROVIDE
<br /> 04NER NAME
<br /> beir/C4 4 S5/ &4 51'sy4/)(.cU^e4,. 4 ❑Zoning Status; CUP;
<br /> OVVIkR ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM•O �y I cf /3/%0ekl1f Al/ ",J ,C3- 1 / Variance(# )
<br /> HI'MEPHONE CEL HONE EMAIL ADDRESS •
<br /> L 6:.i „% ; .0,i 0e r-1 716 I A)6/V-C ❑Site Plan drawn to scale
<br /> AGENT. INFORMATION, `°
<br /> .CONTRACTOR,INFORMATION �.t�t}_ ,_, and includes dimensions
<br /> 'AGENT NAME CONTRACTOR NAME n
<br /> n/U,�/-( -5-c rest'1SQh 8ro s ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR DRESS of well/septic
<br /> ,x' 90Itwy / V .
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> /3 rod K/p'J w LJ 5-3 a"Z/
<br /> a ., -ftt N1 wL.,... }.Y'* _ •a— ,,._NE ❑Site Plan approval from
<br /> Y PiiUIVC
<br /> G O 8 y'J')-6 O %t/ applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS •
<br /> JN,•L ❑Floor plans to scale
<br /> PROPERTY/LOCATION INFORM ATION !(http//accessdane co d____wi;us, r_
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR GE. . ❑Elevation of property
<br /> PARCEL g ,Q i ) frontage drawn to scale.
<br /> 1111 PARCEL t�S-IU—.2�/ .s/L�-b // /a/�xJ ��Q> 0
<br /> TOWNSHIP: SECTION:
<br /> Ko 4d a 9 /4:V!(.4) /4/4: S(,v ❑Driveway permits
<br /> (state,county,town)
<br /> ADDRESS: Sec.-.2 y -r-lo to/),tS J r/y air;yy y 6,41,'
<br /> e2 / 0 y ( (I ,$CC S to e-,'r TK N890E6E $/,/. I FT'Tv ❑Sanitary permits
<br /> CSM: LOT - _, •. /Y rt4 A 7. CLvN��(public,private)
<br /> -- V `"-o L N : 4 , $ .2? •,
<br /> STAFF REVIEW
<br /> PROJECT DESCRIPTION: • '0 i •a • o • O N = r
<br /> A:tit tiory 7C) P'hehi tic Seie-- )Cro Ta L `U Zoning Dlstnct {
<br /> . ❑This project is a new building or structure. 1 F " `" -�
<br /> D Permitt fCt Use? z•(IJhis project is an addition/alteration to an existing building or structure. u
<br /> ;
<br /> , Tr
<br /> SANITARY SERVICE: PERMIT NUMBER: ® R alAjdreS ti
<br /> EWER PEPTIC qn2W/eXlSting)
<br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) -
<br /> i ❑ Wetland/Floodplain/
<br /> Shbteland(attachment)
<br /> AREA TO NEAREST SQUARE FOOT: w4
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '-
<br /> . ErosionCohtroi mit
<br /> BASEMENT 1ST FLOOR
<br /> /v Z 4, TOTAL SQUARE FOOTAGE j r op dd nce
<br /> 2ND FLOOR: 3RD FLOOR: 4 -,•,a-- ,
<br /> . / V Z ,,--,?y�,& + .`'r s-. W
<br /> _E Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: � r,�,� °c% . and available optionsl
<br /> (Please round to nearest dollar) -► --► ♦ --► ♦ --► v/ • = r,,,�
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes to ['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? [ (Yes o
<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 j o ❑Don't know
<br /> 7. Is this to correct a violation? Efres 5 o
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -► -►
<br /> 545-112(4/09)
<br /> •
<br /> •
<br />
|