|
'tG3
<br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # ea....,
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE 64--
<br /> OWNER NAME
<br /> ,''t y' Ai4RY --lo• �E;A✓EV 1 0 Zoning Status;CUP; 74, , i
<br /> ER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> 7W8 /$b' AXE ,4/) _90e e„-y _ 41/ 415j3 Variance(# ) •
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> BPD. Z5 •,'Z Ail; I(O. 7- :.24° 7 76.e tC« r�S-,,✓ Se'.Er)u • Site Plan drawn to scale
<br /> AGENT INFORMON (CONTRACTOR INFORMATION d includes dimensions
<br /> AGENT NAME CONTRACTOR%MME
<br /> CA6LE Citei76,17 r /i✓G' Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of ll/septic
<br /> Svc S-YE9pio eE . -7/ee -
<br /> (City,State,Zip) (C' State,Zip) .Setbacks
<br /> ;4vx L!iry 6,// S3s8 3
<br /> PHONE pH NE Ite Plan approval from
<br /> za8) 4 /3-y5 7 1 applicable township.
<br /> E-MAIL ADDRESS E AIL ADDRESS , loor plans to scale
<br /> ,1LRur1✓. .e//., ),4,./60.<o
<br /> PROPERTY/LOCATION INFORMATION (http:i/accessdane.co.dane.wins/) Elevation of r0
<br /> PARENT PAR R: CURRENT ZONING:tp://accessdane.co.daAnceR.EAwiEus/) property
<br /> PARCEL • (03 • -/�f5/DE,,,rr•Qc Q frontage drawn to scale.
<br /> NUMBER
<br /> TOWN SECTION:
<br /> /:DX gv,e Y '/a: +/4+/.: J Driveway permits `',
<br /> ADDRESS: / �J (state,county,town)
<br /> 7 '9 8 45 L 4eF '�47.) J Sanitary permits ir
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> (public, private)
<br /> PROPOSED PROJECT INFORMATION
<br /> S v
<br /> v
<br /> "' F
<br /> ' :
<br /> PR ECT DESCRIPTION: -� � p E"'" f� 4. /i.4-: _ .:'�+K �1 },�/�
<br /> ®This P roject is a new building or structure.
<br /> ❑This project is an addition/alteration e a dd Ion/alteration t an existing building P
<br /> to ex s n ui I or structure. ,,,e1..........._„::,„:::,„••••,:::::::::::::„:„:::::::::::::::::::::::::::::::.:::„:::::
<br /> J 9
<br /> 9
<br /> SANITARY SERVICE: PERMIT NUMBER: (:::,:::;:,.,:,::.,.:,,. .,,.;.,.,,,;;
<br /> <:;.-nt I n `:;>:;> : :::z >
<br /> ❑SEWER ,SEPTIC ,: .;;:;;.;;;:<;.;:,,,,,,,, ..:.:;•:,.... ,.„.•
<br /> HEIGHT IN FEET: MR
<br /> NU ER OF STORIES: (Not including basement)
<br /> AREA TO NEAREST SQUARE
<br /> FO OI T:
<br /> above Outside dimensions including unfinished area,attached garages and grade decks or porches)hes '
<br /> F81i# ' r{
<br /> BASEMENT; 1 1ST FLOOR: 0(�,d i1
<br /> nc
<br /> ' (t ) 4 TOTAL SQUARE FOOTAGE: , .qi�11/p/i;I 1 �c/CIL
<br /> 2ND FLOOR: i 3RD FL••R:
<br /> u
<br /> I
<br /> 1
<br /> ESTIMATED CONSTRUCTION COST: /' ;>: jj <;'``pig;.;;:;::;;:
<br /> (Please round to nearest dollar) ♦ ♦ (� "��';,°.:,...-.-;
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NI No Q Don't know
<br /> 2. is there a wetland or floodplain on or near the property? L7 Yes Egi No 0 Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes EINo
<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 10 No ❑Don't know
<br /> 7. Is this to correct a vio tion? ❑Yes ! No
<br /> ‘251° APPLICATION MUST BE SIGNED
<br /> .k (Continue on Back) -► -∎ -►
<br /> ,
<br /> 545112(4J08)
<br />
|