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Dane County <br /> Application Foca <br /> 0~•, .- Department of Planning and Development General: $495 <br /> U ZoningDivision <br /> Mineral Extraction: 1145 <br /> j��"'�I��1 Room 116,City-County Building $1145 <br /> 210 Martin Luther King Jr,Blvd. Communication Tower: <br /> (+53000 RF eng review fee) <br /> • MI Madison,Wisconsin 53703 PERMIT FEES DOUBLE FOR VIOLATIONS OR WHEN WORK HAS <br /> (608)266-4266 STARTED PRIOR TO ISSUANCE OF PERMIT <br /> CONDITIONAL USE PERMIT APPLICATION <br /> APPLICANT INFORMATION <br /> Property Owner Name: Ko �I Agent Name: <br /> Address(Number&Street):99a Address(Number&Street): <br /> t v <br /> Address(City,State,Zip): ,M,fielmt„tghlt,wr,5 5000 Address(City,State,Zip): <br /> Email Address: ttli0v6S qq `p Yil oda Email Address: <br /> PhoneR: T <br /> SITE INFORMATION <br /> Township: Q t, _ ���k.„(,� Parcel Number(s): <br /> uriW 00(4o80{.-233-95.01-7 <br /> Section: o3 rt t Property Address or Location: /O0 i' vs i-i Lay I y i +y 3sf6" <br /> stY -- �5 <br /> Existing Zoning: v.,..,1(_ Proposed Zoning: CUP Code Section(s): <br /> Y DESCRIPTION OF PROPOSED CONDITIONAL USE <br /> Type of conditional use permit(for example:limited family business,animal boarding,mineral extraction,or 1 Is this application being <br /> any other listed conditional use): submitted to correct a violation? <br /> \ry <br /> . c i so � 5 Yes No , <br /> Provide a short but detailed description ofofthe <br /> propo d conditional use: <br /> a vv & l p ov1.d kk- titre-et +0 5i-c-"-- Ylv . W d"t_- ki."4 c l.4- aura( LA" <br /> . •.-- "v"-et;( <br /> 4val, t ok, orw., co r`V.1, 644P lle,"444.4.,e't.- •,5 n 0 I-VAT,P V S f <br /> fiV\ eittota rov. 04 Vn....--5 i s S`c*nw. (.'•Ooh A-o ' otli r+.. V*46 JrwW k."`"4" r o w <br /> bt bob .� 0,.....\ A-uswbor. ovse.\ '" \,:...‘ oft‘A. e�‘...*.4( ss p,l+w..crQ.l is. <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 /> ❑Complete attached 0 Site Plan drawn 0 Detailed 0 Written legal 0 Detailed written 0 Application 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.J <br /> Owner/Agent Signature: i Date: 3 h t'02,1 <br /> J1 <br />