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Dane County Application ries <br /> pq , almond:of Planning end Developmentalmond: 5495 <br /> 'v aL, ,.til\ Zoning Division Mineral Extraction, $1145 <br /> •' 4 ,) ; Room 116,City-County Building Communication Tower: S1145 <br /> i• ,,�t� 210 Martin Luther King Jr.Blvd. (+3000!IF ens review foil) <br /> •sCOYi7',' Madison,Wisconsin 53703 PERMIT FEES oouets FOR VIOlATIONS OR WHEN WORl(HAS <br /> (608)266-4266 STARTED PRIOR TO ISSUANCE OF PERMIT <br /> CONDITIONAL USE PERMIT APPLICATION <br /> _ APPLICANT_INFORMATION <br /> Property Owner Name: \)phrtJ_nife 'ft.3ilAftrAgentName: uO�jeNicix <br /> Address(Number&Street):")919 S ,e c oaek i'<,. Address(Number&Street): -19 S 6 5+41,r,Y.i('h I-i 4. <br /> Address(City,State,Zip): (.itis; Plains . WL S3S28 Address(City,State,Zip): (YD55 Pla;,.1:S , tyli. 63So)9. <br /> Email Address: ')OhrinkiCIQe07)2O•'1 mcti(,C.orAEmail Address: d(•i ,(y`sein e ChorLLS ,/ e.1 <br /> Phones: li Oti ' j'1 1- 08 ' Phones: loot — 6-16-- c y p <br /> SITE INFORMATION <br /> Township:'j(i It rl lir C V U S S f lain Parcel Number(s): 00 o I o 1 01 - 01 2 ` ;o 30— I <br /> p t <br /> Section: Seco 1 N Rb 1 0�� Property Address orLocation: 797,1 S+a 1ecozil 1(i. ( ,(.'ss P/ %4 S /1 <br /> Existing Zoning: Proposed Zoning: "S' CUP Code Section(s): <br /> DESCRIPTION OF PROPOSED CONDITIONAL USE <br /> Type of conditional use permit(for example:limited family business,animal boarding,mineral extraction,or Is this application being <br /> any other listed conditional use): submitted to correct a violation? <br /> Height (.estr1 t oh CA P✓OpOgel �}uxi IIi61. ! 13k.i id Yes Li No Vi <br /> Provides short but detailed description of the proposed conditional use: <br /> eQ e_sYvpi Pe,vm;ss;ov, -1'D �'xceeot hei'Gih1' r Sind\On 04 /02 -tett ye+ <br /> rev ► r+ 1A,inotut Ito -Peri' hr eaCCSsovla bui.1C/l.,3 - ( S-I-2)raja - <br /> GENERAL APPLICATION 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.All <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 controversial__ conditional uses are strongly encouraged to meet with staff prior to submittal. <br /> C3�Completeattached [rdite Plan drawn 0 Detailed afitritten legal f6etalledwritten ITApplication fee(non- <br /> information sheet to scale operational plan description of statement of refundable),payable to <br /> for standards boundaries Intent Dane County Treasurer <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. I (� <br /> Owner/Agent Signature. ; .t" �"��'� Date: LI -) / � J <br />