Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME A <br /> N 'Silk RA N oning Status; CUP; <br /> OWNER ADDRESS (Numm ber,Street,City,State,Zip) Deed Restriction; CSM <br /> $4 L\ Al1n0 2.1- c 4-D MID D L E -ro m I o 1 515 6-1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 444; 556-003 ra re $03 . 1%•• •V PA ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME n,�p n <br /> Cart 6 FPM N 5 H mtnl N I N m c i-f h(R- ' Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) S acks <br /> n iDOLETa N 1 w1 5 3562 <br /> PHONE PHONE ❑Site Pla proval from <br /> 6g 5S6-6 o33 60$ 556-O6 33 _ appli I township. <br /> E-MAIL ADDRESS E-MAIL ADDRES <br /> -ot n fe\tlo , 114■t • GM harm.A VI DmLrtpt;r @, - IAAi i . loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑N EL 0-10$o I{I q Z7 07 —3A "F)5 c- 1.6 <br /> frontage drawn to scale. <br /> NUM UM BER <br /> TOWNSHIP: SECTION: <br /> oNr N OF f11 DOLE TON '/4: '/4'/: ❑Drivewa its <br /> ADDRESS: <br /> (state town) <br /> $M59 }q(iR-P • '• (i-1) 5(P5 5 Sanita •- --' s` <br /> CSM: LOT it SUBDIVISION BLOCK/LOT 9 <br /> (publi ,pri ate <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: �1 <br /> plo p V Tl o N I N cL UI b i N 61 1- Q'et Q of\ ) O i (' t N I IJ(7)_ Wing District <br /> . ❑This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU ER: Rural A. ess <br /> FIEWER lEPTIC Lic (new/. • ? <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /A Z •5 Wetta .4:,, 4...plain/■�l Shor- . . .ttachment) <br /> � <br /> AREA TO NEAREST SQUARE FOOT: ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOO : Erosio ,tn ♦' permit <br /> 4 Z y k Z 7.e% j TOTAL SQUARE FOOTAGE: 4, (slopes " t. lance, <br /> 2ND FLOOR: 3RD FLOOR: fillip!,=CIreSS) <br /> 0 0 5 Z$ <br /> wi-(cati.n. Y <br /> ESTIMATED CONSTRUCTION COST: �f j r + 0D0 aval(Bb - .a.tlon <br /> (Please round to nearest dollar) ♦ ♦ -. ♦ S 7 <br /> W <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't n. <br /> 2. Is there a wetland or floodplain on or near the property? Dies IgNo :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes :No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes No <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) ❑Yes 'lo ❑Don't know <br /> 7. Is this to correct a violation? :Yes Rio <br /> 3 . ToWN OF MIDOl-raN S IP Z et-ED zopINl, <br /> 1 elt•t4IT FIR'S+-r • APPLICATION MUST BE SIGNED <br /> (Continue on Back) —1 —1 —* <br /> 545-112(4/08) �— <br />