|
aSUP,IP+LEMENT<to Web App
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> :PROPERTY O WNER INFORMATION' _ _. ,.-.. ,,, ,.._' ,._, '�_ ;,4 g .; CUSTOMER TO PROVIDE
<br /> OWNER NAME ``JJ nn
<br /> owNERESS (Number,Ste5Ci/1ate,Zp) [Zoning Status; CUP;
<br /> _ Deed Restriction;CSM
<br /> Variance(# ft.'Z )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 22.5 2403 - der e/ - 5-;-/ve/7%0// • C. M/.ite Plan drawn to scale
<br /> .-
<br /> AGENT.7NFORIVIATION ,` CONTRACTOR,INFORMATION�,.f,�t",r,r �� and includes dimensions
<br /> 'AGENT NAME CONTRACTOR NAME /� /
<br /> TTcSh -a,iy IWGy( s� 'Yri A and el; Li►•ite Plan including location
<br /> AGENT ADDRESS CO( CT ADDRESS p of well/septic
<br /> 7O R:vtg-s rd/e V 77 oa /'i. i,s-G(E' l�,l .
<br /> (City,Stale,Zip) (City,State,Zip) mISetbacks
<br /> V&z- k Z 5 35 93 ve/�a 60 7 3��3 Site Plana royal from
<br /> PHON PHONE pp
<br /> . 27' g7-2"/ - applicable township.
<br /> E-MAIL ADDRESS / E-MAIL ADDRESS
<br /> J0 . -- 6.k e° [✓f Floor plans to scale
<br /> `PROPERTY/LOCATIGN INFORMATION, •(http/laccessdane co,dane wi us>) -r= x
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE . ©Elevation of property
<br /> IIIPARCEL - / frontage drawn to scale.
<br /> NUMBER T�`7--/ 1�— Z- o.3,59 Ae
<br /> TOWNSHIP: SECTION:
<br /> •
<br /> &y-n er0-0-e- ,3S 1/4. /4,/4_ (state, permits
<br /> ADDRESS: �/ (state,county,town)
<br /> —3S.1 q F__,4,314_tr1 F`D• Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> / i I //_ / S (public,private)
<br /> PROPOSED PROJECT INFORMATION x r- - .,*_:-, ,.. FF REVIEW
<br /> PROJECT DESCRIPTION: c / =Yr r`'' ,. •� -+*t'
<br /> / / 2 C 5y c-t%`d'7 S i`l it -I-a-144 li Ii cG►1e O ZOn.i g_Dlstnctt kt ,;:v
<br /> his project is a new building or structure. i E Perfiii f :ciF e? 4
<br /> This project is an addition/alteration to an existing building or structure. � 3
<br /> SANITARY SERVICE PERMIT NUMBER: " yRU�ralAddress } °P" y_
<br /> /� +N v. .,,0 pct^
<br /> [)EWER PTIC /3 —2O/ 7 -00654 s ey.,(L(L' °7`' :r. ` ?
<br /> nY (new7ezlst�nT-'44 1:;:3
<br /> Le `:. A `cw t
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ,,,,, ,'r
<br /> C ' 1 ® Wetla d/Floodpial /, '
<br /> f'.-Shoiela'nd (a"itac�hment)
<br /> AREA TO NEAREST SQUARE FOOT: 1102:4` ` ='`:-,r;-. j 1k s-� '% •
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) _a - r,t4 : r
<br /> BASEMENT 1ST FLOOR:22B Q >0 �r lOnCOntrAl R '-
<br /> j,TOTAL SQUARE FOOTAGE: 4, YkslOpes�c�istClrbanee � h
<br /> r filutg acoess . _
<br /> 2ND FLOOR 3RD FLOOR : r 4sg-.':
<br /> I R evle wLa•n St oey
<br /> ESTIMATED CONSTRUCTION COST: OW and avirat o l51 ;
<br /> (Please round to nearest dollar) II- * 3
<br /> ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes ®6lo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Dyes 24to DDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ElYes allo
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - ['Yes ?[ Po
<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) Dyes alo DDon't know
<br /> 7. Is this to correct a violation?- DYes ON
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —►
<br /> 545-112(4Ae) .
<br />
|