|
if e..' ( re-2071`C G5 2_5 (eso
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME ',
<br /> 41 -IlJ 5, � ail Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 6/3.8 iti6-5, 1-"Q0 ,, /lm2,s0ti, lux 53,71f Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> ;11 0 6)gl/S'3 A30 Cpite Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 40 4f�r 6Q f/rr,CtW ,,LL.= j /./t-r rct e&" 7., -'-ems Ste Plan including location
<br /> AGENT ADDRE S
<br /> CONTRACTOR ADDRESS ofyrell/septic
<br /> /v ///7/C4245-Sr- Let.) /036 /1-1 Itc-12EsT' IN'- -
<br /> (City,State,Zip) - (City,State,Zip) _ 7 , U Setbacks
<br /> 0Rte,0.i y` 53.920 026619A1,, s
<br /> X 35
<br /> yi-roK, \\ P,�!ONE Ote Plan approval from
<br /> lbo 3s`9gcq (bOff1o?/o20yzo (c' '/f) Q ,ff�3s i re-c/ (6 afda ,2cy2t&ll) applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS '
<br /> UQ e447-0 n e t0 ae/ to 41 Pact/7'41e,1 tp ,I.62/. to-'- �/Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) %+
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property
<br /> ❑ PARCEL C-9-- frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION:
<br /> ktl-.6 /f- 1/a: '/4'/4: Driveway permits
<br /> ADDRESS: (state, county,town)
<br /> b y3 3 �1ltSb,ft 40 ,,�i9--O'sew, w'z 53`1 r y Atig*iitary I permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private)
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION: `
<br /> /R',0 pit s/v 70 en5i a l /llPf`e"-ki e 5 •246 i S h�-0 Zoning District
<br /> . CI This project is a new building or structure. Permitted Use?
<br /> 01 This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NU ❑ Rural :•• -
<br /> ❑SEWER &PTIC ne /exi 'ing
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)
<br /> / t �, a tland/Floodplain/
<br /> AREA NEAREST SQUARE FOOT: Sh land (attachment)
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> rosionControl permit
<br /> BASEMENT: 1ST FLOOR:eXi5 nM le,ap0 Sf
<br /> 1 TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance,
<br /> Aim rroi,, - 6� sP' filling/access) 1....551A -O -
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 'Y` Die 13,t -eview Location Survey
<br /> ESTIMATED CONSTRUCTION COST: ♦ --► ♦ —I. ♦ --► � dea U0 and available options.
<br /> (Please round to nearest dollar)
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes If No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? tfl-Yes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 6i.1Ces ❑No
<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) ❑Yeso ❑Don't know
<br /> 7. Is this to correct a violation? Cl Yes ekNo
<br /> w,,, .;. APPLICATION MUST BE SIGNED
<br /> (Continue on Back)
<br /> 545-112(4/08)
<br />
|