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<br /> ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App #
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> ill 1 C I4AEL N Eti J ❑Zoning S t ; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Res Iction; CSM
<br /> '14254 Ctinve/DDO pR.tyi.. 0RE6D'J, wi. S. 351C
<br /> Variance(# )
<br /> HOME PHONE l CELL PHONE E-MAIL ADDRESS
<br /> 403 - BIS- i8L' (,o&-281-8137_ rnic‘lc,c\ .At4 @otf; ' (ege, ❑Site Plan r ntoscale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ s dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> N OM C- WOILV:S R.E.Anaor L t p.,k ❑Site Plan i I mg location
<br /> AGENT ADDRESS ONTRACTOR ADDRESS of well/sep
<br /> ‘°5 .b 1'J, C,1-.w 06_) Dr.
<br /> (City,State,Zip) (City.State,Zip) ❑Set ks
<br /> PA k0CVC , , t-,, / w ‘ S 3SeZ
<br /> PHONE PHONE El Site Pla :pp ".-1 •m
<br /> `,L-5_ 3 Z.._ k,ko L applica.,- : s 'p.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> (.;atIP .. ,r)0,,-,,r c;,6„,- ,,. , (?,—.„,.W n ,c,,,, ❑ Floor p to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/)
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation Of p erty
<br /> ❑PARCEL O4 /o�.01L-%?o-D 14A-2., Z15- frontage r wn to scale.
<br /> NUMBER !�/
<br /> TOWNSHIP: SECTI iver/
<br /> r0 Rf C10ti N W '/a: 14 V✓ '/4'/4: El Drivew., p: f4ts
<br /> ADDRESS: (state, a, i , .wn)
<br /> lo2a 4 Ci2E sT w41uD DQAvi... ORCo..J , wr
<br /> CSM: LOT SUBDIVISION BLOCK/LOT \pU ry•ea its
<br /> ' elD 2 csMo08g1, )
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION:
<br /> f. XPAnz, s 11c. 0C Exws■oc, E7�,04. ❑ Zonint‘ct
<br /> ❑This project is a new building or structure. Perrnitt ?
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Addr-
<br /> EWER WEPTIC (new/ex'JO
<br /> l
<br /> HEIGHT IN FEET: t . i NUMBER OF STORIES: (Not including basement) ❑ Vltetland/ ODO
<br /> ` Shorela ment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) •
<br /> BASEMENT: 1ST FLOOR: ❑
<br /> Erosion *n •f p u�
<br /> j TOTAL SQUARE FOOTAGE: j (slop-/*'- ,- ,ce,
<br /> 2ND FLOOR: 3RD FLOOR: filling/.« ~
<br /> �- '� & ❑ Review • :1,4,,,t., .
<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ 7,- O 00 and av!ll -.r�• •ns.
<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 [ to ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Jlo ODon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ]Yes D"lo
<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) Ekes ❑No ®Don't know
<br /> 7. Is this to correct a violation? Dyes EINo
<br /> 29 60 g/2,4%./ 7-
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(aioe) (Continue on Back) ■ —► —►
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