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10SS
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> OPERTYOWNE' SIN ORIYIATIQN'w s, '-:', ',`~"= '`"''� ' NqK ..
<br /> :_ _ ma c ` . 4 ;s-. ?�w r te, . :: C U T O MR TO PROViDE
<br /> OWNER NAME
<br /> 3-Am.c MAxt1.£ Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) D-ed Restriction; CSM
<br /> 33 C.0"'1-Y &J. g 5-7oc>6tvrar/,t...t ariance(# )
<br /> -HOMEPHONE --• AIL ADDRESS
<br /> 669-873--SS/4 • site Plan drawn to scale .
<br /> 'AGENTIN ITtM ATI`_O'.N _�•."7—_r `�, CONT.Rffeli INFORIN%1TION nd includes dimensions
<br /> ' AGENT NAME CONTRACTOR NAME .
<br /> C.Lf4fZy per,Lp,,,i‘ C.64+P S'a Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS - well/septic
<br /> - /.O PAoc.i ST •
<br /> (City,State,Zip) (City,State,Zip) Setbacks •
<br /> tJ�.t),,VP w I
<br /> PHONE PHONE ❑Site Plan a oval from
<br /> kg.-3,4 ro t 3 a. PPlicab ownship.
<br /> E-MAILADDRESS E-MAILADDRESS .
<br /> -1.--tcs.s,c eGLtn-14•1 b,,,4-4,,..a, Floor plans to scale
<br /> ;.ROPERTY/LOCATION'INFOitiiig die niittp•Ualaessdaneeafallie�ir usiWkW
<br /> PARENT PARCEL NUMBER: CURRENT ZON N ACREAGE . Elevation of property
<br /> . PARCEL Ei NUMBER 646 near,-� - / X 7� frontage drawn to scale.
<br /> �o6 i( -31; � � `
<br /> • TOWNSHIP: SECTION: .5
<br /> fL�/OSa-rvr Sl�eiAid j %4: -+�+� '/a%a: - 0. Drive y permits
<br /> ADDRESS: J ( e,county,town)
<br /> 3033 /NAT"( kFw'/ ' ❑Sanit.•'p its
<br /> CSM: LOT SUBDIVISION BLOCK/LOT •.'.IIC,private)
<br /> Oo a4 3 .
<br /> - ---- -- - - _ - _ ,i: w' - '�3...—?.�^ .L_ -5,,, ''?- _GaS , :...,-.. _ _- -- ..C,2 F•E.
<br /> PROPOSED PROJECT:INFORMATION . f "z3,1?4 5: .r -_: may. W.•,..7:1!--5'�S 'FP RE-\[IEW rf
<br /> PROJECT DESCRIPTION: ;'~-� Y " - �, r � `'1
<br /> ( e r►--tro t -:Z•. •in'DisTnct; : ' fRot.
<br /> • 3x/ S 9 .N•-t -
<br /> tf;.'r,''"r� I3-1'' sx..6--ice,
<br /> This project is a new building or structure. MI etmit d Sel ,-4r
<br /> This project is an addition/alteration to an.existing building or structure. �'„ ` .- � ' ?
<br /> SANITARY SERVICE PERMIT NUMBER: -..3 •,,v-r ��~
<br /> S� Fes ,,q �.._- �d�%�y��'
<br /> =- (new7e st r g) - °O T
<br /> EWER �3EPTIC :v_ 1 •..:� t..
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) F" ? ',,;;6 -.:_;4==' f....-4"4.:S47;,........
<br /> u r� r't
<br /> I t - - �( d-/Flo • air/ :-_.. _ .
<br /> *-„,2,-.4,23.-e:tShOrela".±{attach
<br /> AREA TO NEAREST SQUARE FOOT: y =„13'5,-°�:• _. _ ..:,:
<br /> . (Outside dimensions including unfinished area attached garages and above grade decks or porches) � -5v;M=-.=:n”I-::s.�r -;.:
<br /> ' iElb:SIQpCO •._pe�Imiekw
<br /> BASEMENT 1ST FLOOR: i- y= =-�!=c--=`
<br /> 4, TOTAL SQUARE FOOTAGE: 4, iS eS- % stuifiance ° L •
<br /> lu1 7=cress .,..,,.:- I`--"X.
<br /> 2ND FLOOR: 3RD FLOOR: . c_z ="" ,"sr_ .6 3'_s:;.,
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<br /> .,evewLocatIIS ey_
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<br /> C'j ESTIMATED CONSTRUCTION COST: fs aaralabie o. maTl2� "—1,- ♦ -10- -0•• 'P(Please round to nearest dollar) /o +ae '4 " W r s ` r,
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yeso QDon't know
<br /> • .2. Is there a wetland or floodplain on or near the property? • nYes 1- 11-6.-
<br /> '"" f]Don't know
<br /> 3.Have you talked with the township about your project and are they in agreement? I—Yes --'iQo
<br /> 4:Has there been a zoning permit issued for this property in the past 5 years? nYes 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) nl es o Don't know
<br /> 7. Is this to correct a violation?- []Yes No
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<br /> � APPLICATION MUST BE SIGNED
<br /> �' S (Continue on Back) —► -4- -+
<br /> 545-112(40D8) (`(,J�
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