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Ce A 7,-7,
<br /> SUPPLEMENT to WebApp II
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
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<br /> CUSTOMER TO PROVIDE
<br /> PROPERTY OWNER INFORMATION
<br /> 01lER NAME , ,,,..,
<br /> + .1 C--k- -..1_611-1.Li ct-, YM-1-C---L-(-e- _
<br /> Zoning Status:CUP:
<br /> Deed Restriction;CSM_ EI
<br /> OWNL R ADDRESS (Number,Street,City,Stall a? - / '
<br /> 3 2 Z.8_31clif vuict.y itYci iy 0. , IA tiV 5374-)Li Viariance(At 094/ )
<br /> E-MAIL ADDRESS
<br /> HOME PHONE ELL PH NC
<br /> *g_ 574 Lig 4 , ,os, I3s,_ .,1 , fyi I
<br /> . 1 e,C aril , il Site PI n d n to scale
<br /> AGENT INFORMATION I COIN TRACTOR INFORMATION and in es dimensions
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<br /> AGENT NAME ,2 1E, CON (ACTOR NAME
<br /> ,k1.41 a
<br /> 1 Site P an' cluding location
<br /> ndfrici 'Pet r Brae" rk ut 1
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of weleptic
<br /> —?26,7 69-a..ris atorry 010 320. _n- ii 0 (2-K " /4
<br /> -- 1-4Setbacks
<br /> (City,State Lin) ' ' . (City,Stale,Ztp)
<br /> 011c1/if!e3Ac' 53533 33
<br /> 1)04 VI lie 6.'cli 535 ---- ri
<br /> t ,__,Site Plan p rorn
<br /> PHONE ,-J PHONE
<br /> (POE- 574/ /7/0 /WO applicabi t . 'p.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> Paf k-inCigliSki/14i(rn l I((i)6m1 Cart Parktlic...drtskud-;6771/6 4 6/Wtit1()°r Planale
<br /> PROPERTY/LOCATION INFORMATION (httaulloccossdano.co.dono.wLusi) U'Elevation of property
<br /> PARENT PARCEL NUMBER, CURRENT ZONING. ACREAGE.
<br /> frontage drawn to scale.
<br /> El PARCEL
<br /> 070 7 /// 9soo -2
<br /> TOWNSHIP, SE-C-T1W—
<br /> ‘riveway er s
<br /> lovvn c Cross c.6 tis 1/ Y.: Ai g Y.: 57:-
<br /> _.., (state,co ,town)
<br /> ADDRESS
<br /> 2 1 81 5-11@eccoch 126 Sanitary per its
<br /> csm i LOT SUBDIVISION BLOCK/LOT (publi. pr' ate) if'2 ir
<br /> Oq187 2_,
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT WSCRIPTTON:
<br /> /?C11/ / fil ni i/Y /0276,4 re5;Ctenba it Sir Uditre- LI
<br /> __ Zonikef<rict
<br /> - LSI his project is a new building or structure.
<br /> J PerinVI Use?
<br /> OThis project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE --rf;ERMIT NUMBER. J Rule]Address s
<br /> 1-EWER o Epm /3-26)21-oc),(Y,a/ 40 /existing)
<br /> HEIGHT IN FEET NUMBER OF STORIES (Not including basement)
<br /> . a.,Coi
<br /> J Well /For • ain/
<br /> - n .tt.• merir- *I'
<br /> AREA TO NEAREST SQUARE FOOT: Shore rr
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)i Lir-,
<br /> ErosionControl permit •
<br /> BASEMENT. 1ST FLOOR:
<br /> NA- —
<br /> ,5 /3 4, TOTAL SQUARE FOOTAGE: 4,I (s101Sealrcop • 0E)
<br /> 2ND FLOOR. 3RD FLOOR. „ filling ccel
<br /> • •0
<br /> /92_ /vg- Revieviluck Survey
<br /> ESTIMATED CONSTRUCTION COST.• --
<br /> (Please round to nearest dollar) —ip. —* —IP —10. —Jo —0. $ ,,,550 600 and a‘ ' options.
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<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es III o DDon't know
<br /> 2. Is there a wetland or floodplain on or near the property? JYes "1 o ODon't know
<br /> alhh.
<br /> 3. Have you talked with the township about your project and are they in agreement?.... tgYes 1111 0
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElYes 'c4,40
<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 WI'o DDon't know
<br /> 7. Is this to correct a violation? Des 151 o
<br /> APPLICATION MUST BE SIGNED
<br /> 545.1121455, (Continue on Back} .4, -+ ...
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