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p Km s l Cct) : I V) 13 t"(i d 1&A)0 k , V e,+-off, UJ( <br /> ONING PERMIT APPLICATION www.counryofdane.colil suPPLEMENT_to web-400.4'?. <br /> PROPERTY OWNER INFORMATION -35°`, , z C ' OL Ef TO PROVIDE <br /> VIeay toAct Al Sancta (ew uv- uc i0. "Bo-ere) re) Zo in Status; CUP; <br /> OWNERADDRESS (Number,Street,City,State,Zip),M�' 1 (� g <br /> N. INIi1A bir�cj: PO X 4574 41&d i 1l t uV i 53 TJ91-1 D ea Ree(#fiction;CSM ) <br /> f <br /> HOME HON CELL PHONE E-MAILADDRESS &• ctartl_ <br /> 10d-olIQ=/l7 a dcwla .bctrre <br /> cr 5-.i �i _L., i Site Ian drawn_to scale <br /> AGENT INFORMATION,`: CONTRACTOR INFORMATION;' rt `- <br /> '. �. k<s.q an• includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> DahGL Barre ► : to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS i f well/septic <br /> 6 1',O • ox 457L ? <br /> (City,State,Zip) (City,State,Zip) IN .etbacks <br /> HadiSvY W 1 53-7 Li9 <br /> PHONE PHONE ❑Site Plan proval from <br /> (()0&- OlC( - (li] a a pf letownshi . <br /> E-MAILADDRESS E-MAILADDRESS • <br /> a/hq log+.'i'[t.eavi-larrI GI rrv15�e{t t' ,orc Floor pla o scale <br /> PROP RTY/LOCATION-INFORMATION;' tt;a/- - ' Y,:t, <br /> ( - •_.� t.., _. Elevation of 5-o <br /> PARENT PARCEL NUMBER: CURRENT ZONING A R , GE: P pe <br /> PARCEL /0` p - f {y E J C ♦ A9) 3c( t frontage drawn scale. <br /> NUMBER ('tr�L�O �Ci�r 1 5 �O 'Q V l 4'D <br /> TOWNSHIP: SECTION: n„„„„\11 <br /> V eVOr(;t G— 14: A ' 1 4%4: Y v Drivew permits <br /> ADDRESS: J (St COUnty, n) <br /> (110-hVa,;iIna ) ' 111 (3 Mid i Rd� Ve ronq w L 5 35 �Sanita ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOTf 0 <br /> Ii P. P''c" • r a (' .ub' ,private) <br /> ':OL. oc(eviSln,iv 3Fcl,01 (e) tD∎,v It , I'31)1 to X. ' <br /> PROPOSED PROJECT INFORMATION 'STAFF REVIEW <br /> PROJECTTDESCRIPTION: / 1 `� �([/ �, <br /> f frpe YetZ,v� /PP- ( W 2 Qre r 011,4 i ._a) v l\! 3 Zoning blstnct fl <br /> U J �h • { 3 : <br /> (This project is a new building or structure. �r , ~ 1 <br /> � ,Permitter o `?_ � i'1 `- <br /> ❑This project is an addition/alteration to an existing building or structure.;.- ` F -� : <br /> SANITARY SERVICE: ® T x <br /> PERMIT NUMBER: I RUralr CldreSS '- <br /> EWER No �EPTIC tsj 0 r \ ' (new/ x1stln <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) - <br /> tp P r0X. S Te e+ I ❑ Wetland/▪F odplall7/ - <br /> AREA TO NEAREST SQUARE FOOT: r <br /> Shor d 06-74 ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ® r _ <br /> ErosionCo► ol:` mit <br /> BASEMENT: 1ST FLOOR }, „ NP�.,,.,; <br /> -^ Q I X L1 0 l_ Q o j TOTAL SQUARE FOOTAGE: sib e-s isturrbance <br /> O 1 �J 1 s I • cress) K <br /> 2ND FLOOR: 3RD FLOOR <br /> Revigia:05afior1$11-03 <br /> (Please ounnd o nea est oll )COST: ♦ ♦ ♦ ♦ ♦ ♦ `'aCl � end avails"bie optionsx <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ViNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ININo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Olo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ®Yes ONo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) ,AJO <br /> 6. Is a location survey required? (see reverse) QYes g o QDon't know <br /> 7. Is this to correct a violation? QYes F,,?No <br /> .�- <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) —. —► <br />