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ZONING PERMIT APPLICATION www.countyofdane.com = UPPLEMENT to Web•App#
<br /> PROPERTY'OWNER'iNFORMATION _ ,i.5 f M"` g ,: .:`r =_ r�r;-rat:.i-V,`i CUSTOMER TO PROVIDE
<br /> OWNER NAME F,�i� ,,r` r
<br /> ' `r 4'ACLL fiAlify oning Status; CUP;
<br /> S ( , , ty, a e,Zi 1R2SrlCtlon; CSM
<br /> MMR C �S)l` S�`7 (A Variance t )
<br /> /WNERADDRESNumberStreetciStP
<br /> OME PHONE,q CELL PHONE -MAIL ADDRESS Deed Restriction;
<br /> /6 '.661-7-11 7-11 I 6 bi 1.1 3')(o 7 ra_cictt tt er® CO" q.s....ita-rilan drawn to scale
<br /> AGENT?INFORMATIOItI,,,•" .' , rCONT INFOR IgT10iN y '{:' and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Ian including location
<br /> AGENT ADORES-. CONTRACTO DDRESS of well/septic
<br /> (City,State,Zip) s (City,State,Zip) etbacks
<br /> PHONE / PHONE S an approval from
<br /> applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS - •
<br /> F plans to scale
<br /> PROPERTYILOOATION-INFOiMA1 ION ;(http.Uaccessdalne_ co,dane vlrl.us/') ^� `., n Elevati property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: L�J _
<br /> NUMBER OI1b �1It--1v1.-V190-" IL ki —1 2.,&� ppp. ""' wn to scale.
<br /> TOWNSHIP: - SECTION:
<br /> 7 T D„F Co-6y, 1 ./: N kl ��4��4: ( iveway permits di .ADDRESS: ° 5tate, COUn , ow
<br /> CSM: LOT r y���� SUBDIVISION BLOCK/LOT anitary permits
<br /> It-t s VI (public, private)
<br /> ($6
<br /> PROPOSED PROJECT-INFORMATION,- ; '° , . - 'S 7tP *-ii
<br /> PROJECT DESCRIPTION: p _,- R • - 1,
<br /> M ) �J� —//[) c ( m.,�®ia'e DJ 13CV� ' £T
<br /> R'rhis project is a new building or structure. �`� d +
<br /> [This project is an addition/alteration to an existing building or structure. y iraT r �
<br /> SANITARY SERVICE: PERMIT NUMBER: t €- �@ e_ c k -- E
<br /> , , .�=.
<br /> n- WER M.EPTIC J"' d OA .� ,-.:;: , ! ;��--t,,,
<br /> HEIGHT IN FEET f4/ i NUMBER OF STORIES: (Not including basement) 4 .m '— -
<br /> 1,
<br /> AREA TO NEAREST SQUARE FOOT y ��, 1:fl,(Outside dimensions including unfinished area attached garages and above grade decks or porches) yv ' y •,
<br /> BASEMENT: 1ST FLOOR: D e �_s r..-V4,7__
<br /> nf.t•,�.I - TOTAL SQUARE FOOTAGE s. _ r @ �° .
<br /> 2ND FLOOR: 3RD FLOOR: —7� �_�--� '�1 Z= g= �
<br /> ESTIMATED CONSTRUCTION COST $ ,,/ '''-- m P_�.4.
<br /> (Please round to nearest dollar) ♦ "� ■ -� -+ �V �j V i/� _--:- may._ ,----
<br /> - . . . ., kia -
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Q1' s - [ lo- Don't-know
<br /> 2. Is there a wetland or floodplain on or near the property? [ Yes ONo .QDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Degs ONo. .
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? 01'es [2] I0 • .
<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) Des lo . ❑Don't know
<br /> 7. Is this to correct a violation? - QYes LSD
<br /> •
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) •-+ -► ->
<br /> 545-112(4ro6) -
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