|
• c2e
<br /> 1 le
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#
<br /> PROPERTY OWNER INFORMATION ;;: .. .;.; ' i,'; V- ,„;, . .t._ 1. GUSTO ER TO PROVIDE
<br /> OWNER NAME
<br /> PV;J c �
<br /> l—c r�
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) oning Status;CUP;
<br /> 7 3 7 9 Sz/y ti//i f J Alan,:so x. w1- 53 Deed Restriction;CSM
<br /> Variance(# )
<br /> HOME PHONE Q h
<br /> CELL PHONE E-MAIL ADDRESS
<br /> & 37 - a°TSB 3 5- QZ3”
<br /> al'Site Plan drawn to scale
<br /> AGENT INFORMATION : : CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> fi /I 4 J e /45 de n dd 5 1,o// G v S}0 4. 644 a Site Plan including location
<br /> AGENT 'J ADDRES/SS /5 (f CONTRACTOR ADDRESS of well/septic
<br /> -' , 0 x /5 O I>G - aa,,_ /C�
<br /> (City,State,Zip) 3 Z (City,State,Zip) ( Mr
<br /> J Setbacks
<br /> f /c y e,3 c.-�- .S 9 ii- 33? ' its
<br /> PHONE PHONE 11 . e Plan approval from
<br /> Z Z S ' 2$V Z?� — y z-S D applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> loor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wims/) . E. Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y
<br /> LI PARCEL frontage drawn to scale.
<br /> NUMBER
<br /> TOWNSHIP: SECTION: 3
<br /> /D w C fj„r k 2 p '/4: 4, L 1/41/4: Ai c✓ IL' v riveway permits
<br /> ADDRESS: ) state,county,town)
<br /> 4 4 I rW �
<br /> 3 �' , anitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private)
<br /> PROPOSED PROJECT INFORMATION - ,., , ,
<br /> PROJECT DESCRIPTION: ff t - a" °'
<br /> Gc ,, 4y-c /9Ud,.4,'o 'T a m ,�
<br /> LI This project is a new building or structure.
<br /> LitThis project is an addition/alteration to an existing building or structure. ,V L
<br /> gt `rioi/ 7,V1‘!',314
<br /> SANITARY SERVICE: � � s,�t� � ,�
<br /> ❑SEWER b EPTIC ,t, a,,ia
<br /> HEIGHT IN FEET: (� 0 NUMBER OF STORIES: (Not including basement) , `
<br /> AREA TO NEAREST SQUARE FOOT: ,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) mot
<br /> BASEMENT: 1ST FLOOR: ,;�� r a r' r s
<br /> 4, TOTAL SQUARE FOOTAGE: j r r ."?1.t
<br /> 2ND FLOOR: 3RD FLOOR: �•, ;,
<br /> 37-a , i , „ , ;,
<br /> ESTIMATED CONSTRUCTION COST: 1 '' �e, o�- t >,:
<br /> s�
<br /> (Please round to nearest dollar) '� "� "� "� $ ,�? o o (�
<br /> re I e rely
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I& , o ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes i. o ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes P%1 o
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Flo
<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 ❑No ❑Don't know
<br /> 7. Is this to correct a violation? Yes Gila
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► -♦
<br /> 545-112(4/08)
<br />
|