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Dane County ----"ipr...s- ---- - ----
<br /> 1,4Department
<br /> , .
<br /> '.641Ett:- . . Zoning Divisionof Planning and Development Gown*
<br /> allneralEstrintiore S495
<br /> $1345
<br /> Room 116,City-County Building WAS
<br /> • ,r Communication Toner:
<br /> '• '''te.V.----. ‘,.'
<br /> .,4,... 1..... _ 210 Martin Luther lOng Jr.Blvd. (•Ss000 RF erg raview fee)
<br /> '•--,5S.0 0/1_6s ' Madison,Wisconsin 53703 PERE=FEES DOME FOR VIOLATIONS OR WHEN WORK HAS
<br /> (608)266-4266 STARTED PINOR TO ISSUANCE OF PERMIT
<br /> CONDITIONAL USE PERMIT APPUCATION
<br /> APPLICANT INFORMATION
<br /> Property Owner
<br /> N . Ite, livoc, Agent Omer ,....
<br /> -
<br /> Addi""Nualber a Street): I/ i 1.-drAe Ice50,15#` PS, Address plumber&Street): 4,,,,, __.
<br /> ....--
<br /> Address Mt State,Zia 5 hrAiceilicot,(Az-, 535 ( Address(City,State,Zip):
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<br /> ,Email Nees= KAKon.o 5 e 67,444 cv.it Email Addreux
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<br /> Phonerk bat.el3-41Z 71 Phone& .-
<br /> WE INFORMATION
<br /> 7....dep: RA,44/44a Parcel Nurnimads): OS 10-C72--go/-0
<br /> Seabee 2. Property Addresser Laced=I tin' lake_ keyetrat AI• 5fv.i.ii fr., (MT—
<br /> Existing bade*Poll Proposed twiny LC.,,. cUP Code Section** 7. I O. 3:1 I
<br /> DESCRIPTION OF PROPOSED CONDMONAL USE
<br /> Type of conditional use permit(for example:limited family business,animal boarding,mineral extraction,orb this application being
<br /> any other listed conditional use):
<br /> 1 I submitted to correct a violation?
<br /> Li(;L+ ‘1,1( ft al Yesfl No a
<br /> -Ni
<br /> Provide a short but detailed description of the proposed conditiorsal tbei
<br /> , pt,e,kk . ..,,,y ri,j,./1/ WA,, cA4.. p 0,isle- (...---1-4A9 F`.4-1(o--+e-:...e.es ._ „,. /1,,,te,,,,i 4 4,06 4,-..yc.„ A. L% dU-14- 60(le-do- ' "E-L
<br /> Go li-r-D i I, bi,64-,
<br /> GENERAL APPUCATION REQUIREMENTS
<br /> Applications will not be accepted until the applicant has met with department staff to review the application and
<br /> determined that all necessary information has been provided.Only complete applications will be accepted.Al!
<br /> information from the checklist below must be included.Note that additional application submittal requirements
<br /> apply for particular uses or as may be required by the Zoning Administrator.Applicants for significant and/or
<br /> potentially controversik conditional uses are strongly encou7ged to meet with staff prior to submittal.
<br /> dOpmpletmatioched Ste Plan drawn El Detailed 61 Written legal El Detailed written 61 Application fee(non-
<br /> information sheet to scale operational plan description of statement of refundable),payableto
<br /> for standards boundaries intent Dane CounlyTreasurer
<br /> I certify by my signature that all information presented herein is true and correct to the best of my knowledge.I hereby
<br /> give permission for staff of the Dane County Department of Planning and Development to enter my property for the
<br /> purpose of collecting information to be used as part of the review of this application.I acknowledge that submittal of
<br /> false or incorrect information may be grounds for denial of this application.
<br /> Owner/Agent Signature: ,--Z______--
<br /> Date: l'-' 15---'7A
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