|
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Bar IA Ns Born$ ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 1580 Vn:°v. (14114,, v 8),(1, E.,.41, ivI 5-35-/S' Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> bob-X67-3323- —__---- b 1110Y-11s 24,,,,,-s'-.cd,.. ❑Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> t4 L4 I lrewy ")-ewz Solar LLL ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> i 3zt E 'Cy,tw, $3. 1324" 6 't 74-9K 34..
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> /1aJ;,.., Na 5-3103 114.1%,, I4T 3-3103
<br /> PHONE PHONE ❑Site Plan approval from
<br /> 608 6 3-'8 yzv S' 6ce 658 '1 28$ applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRES 6.
<br /> y.,"Kw,a dre.. $o/c r.C-5 WI ,r,d rebri d rt,yrlolur.A,.,,., ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property PARCEL PARENT PARCEL NUMBER: CURRENT ZONING:/ ACREAGE:
<br /> ❑NUMBER OWN,- 17-4-1- 4S3 1-7 A—) --)e/het4-1 ,S9 frontage drawn to scale.
<br /> TOWNSHIP SECTION:
<br /> ik.e'v nor.'1- '/a: /,+/4. ❑ Driveway permits
<br /> (state, county,town)
<br /> U 5-80 I>,■., Valhi n.( 0,4 ar4 7 -'5/r
<br /> ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public, private)
<br /> PROPOSED PROJECT INFORMATION ST/041:REVIEW
<br /> PROJECT DESCRIPTION:
<br /> 61^43,j,i)- MOJH')+el cp 2 kV/ Sdar tilt(fr,G Pry A El zonintDistdck.
<br /> . 2This project is a new building o Mall © Permitted Use?
<br /> ['This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER f ralAddress,
<br /> EWER r)EPTIC (new tg)
<br /> HEIGHT IN FEET ) ( NUMBER OF STORIES: (Not including basement)
<br /> 0 Wetiandff1oodpiain/
<br /> AREA TO NEAREST SQUARE FOOT Stare (81nteCtt)
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT 1ST FLOOR:
<br /> 0 Erasnt trmit
<br /> 2ND FLOOR: 3RD FLOOR: TOTAL SQUARE FOOTAGE: ,, si0peS,disturbance,
<br /> 351 f`tingJass)
<br /> 3 Sb 6.1«,- an -A1\ {© Rem DCat
<br /> Survey
<br /> ESTIMATED CONSTRUCTION COST: ! ;and c bleopt`tons.
<br /> (Please round to nearest dollar) 4, ,,
<br /> . ?4• 33
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pon• • akc. ❑Yes IENo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1:BNo ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Sles ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 21No
<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 21No ['Don't know
<br /> 7. Is this to correct a violation? ❑Yes - No
<br /> iS Q L,_ APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -i
<br /> 545-112(4/08)
<br />
|