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<br /> SilloPLEMEWT la 1,110444/17,
<br /> ZONING PERMIT APPLICATION vvvvvv.countyofdane.com
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<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAmE
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<br /> SC1 V.V.%e -I millert. c.k Sc hk,e.c...e.._ 3 Zoning Status;CUP,
<br /> 0.ANER ADDRESS (N,mbet Street.C ty.State.Zip)5D5r6d Restriction: GSM 39, L-i v-Ncot,.. Acg. Dr.ft:i b A iWk 5SS-16'm Variance(# )
<br /> HOME PkONE (CELL PHONE E-MAIL AMR'S SS
<br /> 0-7 i 3'58-(47,1 , schtec .0. matk. CO rrt N'Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION : ,S' and includes Orrfe-r-isions
<br /> AGENT NAME CONTRACTOR NAME
<br /> I 0 Site Pian including location
<br /> AG‘Er,T ADORESS 1 CONTRACTOR ADDRESS cifyiell/septic
<br /> ,C.:1',. S:ate.Z,,:...) (Cly.State.apt _ Setbacks
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<br /> p,ci.,..- i PHONE D Site Pla...r,14Pproval from
<br /> I apolbletown'S'hip
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<br /> E-hiAl_A.,:.iuREss E-RIAILADORESS
<br /> 0 Flooccians to scale
<br /> PROPERTYWCATION INFORMATION L j(http://accessdancaccoodiute.wlousi)‘:=, ,.: .. . r--1
<br /> E] Eleva,nlif property
<br /> PARENT ETRPARCen kr ibl.)RRET ZZG:cr .) ACREA? :pc:AugMLR CS . i. -.• fropttge drawn Jo-scale.
<br /> TOANSHtP SECT ... r.-..-' Y. N . y: ...
<br /> 0 Drivewe,ytermits
<br /> (state(COunty,tolyn)
<br /> AposEsS
<br /> 5 L f tAttA,N. P4& Ore,41.Qt( 535:15— 0 Sanitarype
<br /> .-,..T rmits
<br /> LS ,- % .,-, (.9.... 1 SUBOIvIVON SLOCKILOT
<br /> (,ublie.;.private)
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<br /> PROPOSED PROJECT INFORMATION t;:".;„::::,:i:1, .: ... ; . : .. -', - , :: . :-.' : ( STAFF REVIEW
<br /> PROTECT DESCTP-ION _ r
<br /> POO I ( g0 >4 L101) r....,
<br /> Ni.el Zoning District
<br /> This project is a new building or structure. re:4ermitted Use?
<br /> OThisproject is an additiorplteration to an existing building or struFtu e. (----)
<br /> 7- U
<br /> ,RY SERVICE' 1 PERMIT NmBER. Ai, , 0 Rural ress i
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<br /> FEWER 1-VEPTIC 1 / (new/ isting ,,...---
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<br /> rizE•r• ,NUMBER OF STORIES: (Not tricl ng basement) ,...
<br /> ..........--------' i ,—........._ 0 Wetland/Floo'dplain/ ,.
<br /> Shor,s4(attach,er111
<br /> AREA TO NEAREST SQUARE FOOT. ...,,
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r-.1
<br /> L-I ErosionContniipermit
<br /> BASEMENT. 1STPOOR:
<br /> li I TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance,
<br /> filling/ cess) N .
<br /> 2ND FLOOR 3RD FLOOR:
<br /> 1 200 0.0 7
<br /> 0 Reiew Location Survey )1 ,.::.)\.0
<br /> ESTJAATED CONSTRUCTION COST.
<br /> -4. -4. -4. -4. -1. $ i 2 0) 00C and available options. It
<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? ....... DYes 0,Io EDont know
<br /> 2 Is there a wetland or floodplain on or near the property? DYes ap..o ODon't know
<br /> 3. Have you talked with the township about your project and are they in agreement? jaes UNo
<br /> 4 Has there been a zoning permit issued for this property in the past 5 years? QYes _ o
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank iptione)
<br /> 6. Is a location survey required? (see reverse) 1:1:1Y4 aJo ElDon't know
<br /> 7. Is this to correct a violation'? PVes alo
<br /> ' .....----. APPLICATION MUST BE SIGNED
<br /> P.Ei :. •s ,.
<br /> (Continue on Back) -4. -4. -*
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