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<br /> ZONING PERMIT APPLICATION www.countyofdane.com 'U LEMENT#o lAtebyAp
<br /> ROPERTY;OWNER_INFORMATION:_r . =x f
<br /> . j�_. ;.�_- �.,_ ._. _� ;_ -�-�,.� GUSTt�MEt�TiO PROVIDE
<br /> OWNER NAME /
<br /> / C rn J -E/ U ❑Zoning Sta ; CUP;
<br /> OWNERADDRESS (Number,Street,City,State,Zp) -. ,� Deed riction;CSM
<br /> :7.7 3 0 L✓,1,o LA 1,"`I r( r� C 0 4 i,, / u (-41 S3 ?o2,� Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - -
<br /> 11,-C.-" 2.7 Y-7 7/3y - 016 0 ❑Site Plan aw o scale
<br /> _AGENT1NFORMATION CONTRAC OkINFORMATION _ at _, ' and include imensions
<br /> 'AGENT NAME CONTRACTOR NAME
<br /> • ❑Site PIa In ding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS ofwelUse lc
<br /> (City,Slate,Zp) (City,State,Zip) . ❑Setba
<br /> PHONE PHONE 0 Site Plan , •! om
<br /> applicab t• s4 p.
<br /> E-MAIL ADDRESS E-MAILADDRESS •
<br /> ❑Floor an to scale
<br /> _PROPERTY/LOCATION,INFORMATION htt l/accessdane c&dane vtn us •`
<br /> P n' ` []Elevatlo�0 roperty
<br /> PARENT PARCEL NUMBER CURRENT ZONING ACREAGE . '
<br /> ❑PARCEL / c/ frontage yawn to scale.
<br /> NUMBER • �).[ 0 9�/ D 3,2 7S 0 0 - d
<br /> TOWNSHIP: SECTION:
<br /> %%4: ❑Drivew p r t
<br /> ADDRESS: (state u own)
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Saul r_, n its
<br /> (Publ' , I a
<br /> PROPOSED PROJECT INFORMATION rt' -~f °'-
<br /> PROJECT DESCRIPTION: - ,. : a �
<br /> ��,:a.-
<br /> --C Zontn•1� .S�Vt�f`�' MF�+u�JV.:l-_.
<br /> v«� °--, -it`s-a�-�.yx^'�`:
<br /> This project is a new building or structure. L i F 'watt--
<br /> P.e .ed Use?�"-
<br /> ❑This project is an addition/alteration to an existing building or structure. =, '
<br /> SANITARY SERVICE 1��� _ '�
<br /> PERMIT `"L=lrRUra�Add s s;'- - " -"'-'�--
<br /> r�: tT:
<br /> EWER r)EPTIC m, Cr12W7a;IStl 1•A ?_ li Cj.�„ r_
<br /> HEIGHT IN FEET: l NUMBER OF STORIES: (Not including basement) ^-s �,._•� .,
<br /> 'Oq�.---2, a )F' pal /�
<br /> . Shor-;' '` a '-.hment 4_,
<br /> AREA TO NEAREST SQUARE FOOT i. _'- , 4yr- :•
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) .��. -.=F •_ 3" �i-
<br /> ,, rOS op tit per nit
<br /> BASEMENT: 1ST FLOOR �� =°� '/ 4 4' � :
<br /> J l n! 4.TOTAL SQUARE FOOTAGE:, ,�, SI�4�� � ante; ,,
<br /> (mot --fill . -�.a 4. .
<br /> 2ND FLOOR 3RD FLOOR � ,,.,
<br /> I :, k � TMO-If
<br /> s'" 4 . . ;"rESTIMATED CONSTRUCTION COST -n ,J ;io fia ns.v,♦ ♦ ♦ -+- -0.- -o. Y` .' `' ,(Please round to nearest dollar) w , 4 ;2 %.
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yest<No ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ►v es ao ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? - 'el,es ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - • ❑Yes kZo
<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 • ;2!,• ['Don't know
<br /> 7. Is this to correct a violation?- ❑Yes I: o
<br /> APPLICATION MUST BE SIGNED
<br /> • (Continue on Back) .—► -+ —`
<br /> 545-112(4/08) -
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