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<br /> ZONING PERMIT APPLICATION wlr.countyofdane.com U nnENt#o ►
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<br /> AROPETY ONED INFORMAION _ ,=y ;s - ? .f-MI- .. GUSTO M E R TO PROVIDE
<br /> OWNER NAME
<br /> N)ILJ s►a n1 11 e4,5 PI KIL)S <Zi3 A/.r- )2,14 k c r):i,t?. oning Status; CUP; .t
<br /> OWNERADDRESS(Number,Street,City,State,Zp) - Deed Restriction; CSM '.. ;",`
<br /> • `705 Z .r! I�- s5 cH h. -27• i 1:113514 a11.. �°53s�`'� Variance(# )
<br /> / HOME PHONE CELL PHONE E-MAIL A(DDRESS • - •
<br /> \/ ;C. 625-0 a 0 ' Si an drawn to scale
<br /> 11464TlNFORN101O0. it grr-,;,-,�0 CDNTJRAO ORa'INF.OMATWN` nd includes dimensions
<br /> ' AGENT NAME CONTRACTOR NAME
<br /> ' C GrA 'r Qv/(421.4-4 c..,44?, n Site ncluding location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS o e l/s tic
<br /> /pia Vl LA. 5 r ��
<br /> (City,State,Zp) (City,State,Zip) I QJeibacks
<br /> l/'E.4)r1/0- ii••/ I
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<br /> PHONE PHONE n Site PI royal from
<br /> 4 o 3.,1 -0132. appli township.
<br /> E-MAIL ADDRESS E-MAILADDRESS •
<br /> ,i■ ((f1 4y404<„er.v>S loor plans to scale
<br /> ;.ROPERIWILO CATIONTINFORMATIoN=e(li ijiitaaaessdne'".'co danew uslll
<br /> PARENT PARCEL NUMBER CURRENT ZONING: ACREAGE vation of property .
<br /> • CPARCEL t \ f frontage drawn to scale. -
<br /> NUMBER 070/09a.-6/- X1-5 1 1 -0 tli--(6X'K / /J5. 51,,
<br /> TOWNSHIP: SECTION: ri T7 N C:14 1~1J
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<br /> / Yo 13 1cN /4: sc. //4. „d n Drive ermits
<br /> V ADDRESS: (st c unty,town)
<br /> 7C+5TA.. YAW f 5c14 OS• n Sanity rmits /� c
<br /> CSM: LOT SUBDIVISION BLOCK/LOT (pu p 111'vate) fJ "ay.
<br /> 1175 al
<br /> PROPOSED:PROJECT:INFORMATION_ . ;.,.y: M- ;� ;, ; - -_
<br /> SYAF��1[IEIN�1¢��' •
<br /> PROJECT DESCRIPTION: • r ; iSY� _ _ _Y�,:3y.�.ryK3 '
<br /> 4 'ti'q. Jrm ; .-
<br /> SQU.Ie4 �, v� ._ •: p 4,:d-*'
<br /> This project is a new building or structure. t>P: a,�,. :`Y'_ 1 `
<br /> r t cture. ,`?P itf at e? f
<br /> This project is an addition/alteration to an existing building or structure: ->{.4<=r ,,,- -, "='-
<br /> SANITARY SERVICE € n r ,3 _
<br /> PERMIT NUMBER '�1' -„�=�".-:�'�;':
<br /> 1-- EWER nEPTIC _ ne` �^ tir .: _1
<br /> HEIGHT IN F- C NUMBER OF STORIES: (Not including basement) = 2.4. .if �'_7''
<br /> • 22, - - Ih` ,A"
<br /> ,u�Vetl ���oodplath/�'><=�>"
<br /> �:Sh N—t gitc -2hmei:f— i .
<br /> AREA TO NEAREST SQUARE FOOT: - - = 'u��::
<br /> -.r'�'-';>>`��:? ����:�=tic..... rl,.
<br /> '�l (Outside dimensions including unfinished area;attached garages and above grade decks or porches) ° '` =�r'�� ':•�w=��:t,,:-•s�;�r�:<<
<br /> 13. EroSI.p.oi.,..1 It; •
<br /> BASEMENT: - 1ST FLOOR: • : x }r x r :�rma
<br /> j TOTAL SQUARE FOOTAGE: j ; .Y slope .I urbance= ,t# •
<br /> fl lj ig,accs `'` " w
<br /> 2ND FLOOR � 3RD FLOOR • �: -� -K,,,..-�'-�`-� ate•
<br /> 2443 _._ :%t is
<br /> h6iRevie -5 ration Serve
<br /> ESTIMATED CONSTRUCTION COST: ',- _e` '✓- `v_ `key=
<br /> -' (Please round to nearest dollar) "♦ "'� ♦ "� "♦ "'� ?1 rt :3nd-2 =1_? • options..,;' Or-
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<br /> • 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes No Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? - [Wes Lye's know
<br /> 3. Have you talked with the township about your project and are they in agreement? ®1'es No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - —'Yes ENo
<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 ONo ['Don't know
<br /> 7. Is this to correct a violation?- Yes No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) --I. ♦ -+
<br /> 545-112(4/08) -
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