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<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT;to',WebApp# .
<br /> PROPERTY:.OWNER INFORMATION _ ` r; ' ? {
<br /> x. " _.
<br /> OWNER NAME 1 L Cu' OMERTO PROVIDE
<br /> Wei Wary `# G0.Y11t�l�l g"i-1,t. SSA/ /
<br /> OWNER ADDRESS (Number,Street,City,State, ip) t / ZOflln Status;CUP;
<br /> lam( CO R ") - rcok � � I 55 z Dee Restriction;CSM
<br /> HOME PHONE CELL PHONE 5 { variance(# . )
<br /> E-MAIL E-MAILADDRESS
<br /> .08.142-y.564W ••el.51(0'30`l
<br /> Site Plan drawn to scale
<br /> AGENT INFORMATION, , CONTRACTOR INFORMATION ., r `
<br /> AGENT NAME _,... _ r, ,:, and includes dimensions
<br /> CONTRACTOR NAME
<br /> AGENT ADDRESS 51-014C lU I ((- ❑Sit Ian including location
<br /> CONTRACTOR ADDRESS of ell/septic
<br /> 1x2 I'4-!b Aye_
<br /> (City,State,zip) (City,Stale,Zip) ElAetbacks •
<br /> PHONE litkoAroe , VS__ 535L , :!
<br /> PHONE ❑Site Plan royal from
<br /> E-MAILADDRESS to `l
<br /> . 1-5.locc,c9 appl• e to ship.
<br /> E-MAILADDRESS •
<br /> ❑F or 'ns to scale
<br /> PROPERTY/LOCATION=INFORMATION_'(II(http alaccessdane Codane.wi us/
<br /> ,nom 4,:;..1.7p-,:
<br /> PARENT PARCEL UMBER: CURRENT ZONING ACREAGE: . Elevation of property
<br /> PARCEL o 42 509– ►q�-
<br /> NUMBER -� a-- ( j�� •7 frontage drawn scale.
<br /> TOWNSHIP:
<br /> ADDRESS:vt •firC3OYI S f �lON� �a: -��� t I` ❑DrivewagpelTTlits
<br /> (sty ,county,town)
<br /> "I IL( Co Rd`b° bra,k1 n V11- 5 35 2( ,/
<br /> CSM: LOT SUBDIVISION BLOCIULQT ❑Sanity •ermits
<br /> (pu>; private)
<br /> PROPOSED PROJECT INFORMATION _
<br /> PROJECT DESCRIPTION: ,''+ t'pFF:`IIIE �' s, =
<br /> • This project is a new building or structure, `
<br /> �� A4, ,4
<br /> project is an addition/ Iteration to an existing building or structure. P:.',' '.�Fse? -5 130—`
<br /> SANITARY SERVICE r- 8 °3: ,
<br /> PERMIT NUMBER —•� K4 •-:ys
<br /> TIC k• ..
<br /> C,•e y ,s,ng fZ,e��S3 ,, ��.
<br /> HEIGHT IN FEET \ NUMBER OF STORIES: ( of including basement) b '.;4;-14. `,4',4,0V
<br /> S..6%141%! t •
<br /> AREA TO NEAREST SQUARE FOOT � f il-=?
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) � . ,'' i�
<br /> BASEMENT 1ST FLOOR j J ? 1� 'O r •� `
<br /> �/( ,00
<br /> 4, TOTAL SQUARE FOOTAGE 4, 10,41-01._Ad,-;‘,70.:
<br /> 2ND FLOOR: 3RD FLOOR iFLR �
<br /> ESTIMATED CONSTRUCTION COST: '�' '' -1.,,,
<br /> (Please round to nearest dollar) "► -► -► -. -. -► $ (CDCt C �.C70 . ...,, � "I-' " •. ' • '
<br /> • 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es o
<br /> _r ❑Y �I []Don't know
<br /> 2. Is there a wetland or floodplain on or near the property?.,.—f Sit 61(OS ,JYeS N []Don't Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? BYes Rio
<br /> ,3"■ ( Z.0 I(P
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - EYeS io y
<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 ao []Don't know
<br /> 7. Is this to correct a violation?- '[]Yes taIo
<br /> ACAIUGD
<br /> 545-112(M0) (Continue PPLIT on ON BacMk)ST BE SI NE
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