Laserfiche WebLink
lck,(k - — c,o'1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com 7 i � <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> alOSLP1Vk -4r. C,ot)R'[P1EY F,OL LAN t30 fl Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> a62.1 ?LEASA�JT ST <br /> Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> COVCTWEY. itOL/40 -nut; I •GO ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CtNC:c IJE0MAaa ISh'ttu.J 60+431,34 4.-DES16N „ZN� ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS $�owy�,;� of well/septic <br /> ,..... 3145 DEER PotarO& or sir,' <br /> (City,State.Zip) (City.State,Zip) ❑Setbacks <br /> PHONE PSHONE 13 1 5-3581 El Site Plan approval from <br /> �--� 60e- 871—113/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS "` 1 <br /> 4 c 4 Aetw o■I c erS. co p. ['Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER • fObII"2$Z � f(,/ �", ' SI 5 frontage drawn to scale. <br /> �D <br /> TOWNSHIP: SECTION: <br /> PLE.SAMI St)ft.w iS 1/: /1/4: El Driveway permits <br /> ADDRESS: (state,county,town) <br /> e262%1 Q Lc.Asurf S„C ❑Sanitary permits <br /> CSM: LOT I SUBDIVISION BLOCK/LOT <br /> GowffIIY. ASR (public,private) <br /> r L r; <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: io , �� <br /> PrIT NA (,ARP& 'To i4oK.Se �, <br /> ❑This project is a new building or structure. �� <br /> t .! a/ a *- <br /> ®This project is an addition/alteration to an existing building or structure. '� �" x 1 <br /> S Zi E &As °$ - y <br /> SANITARY SERVICE: PERMIT NUMBER: �O <br /> EWER IgEPTIC g' ' " ` - -"s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> its ' <br /> AREA TO NEAREST SQUARE FOOT: '" *I . <br /> A -, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) F f _ <br /> BASEMENT: 1ST FLOOR: a �� <br /> y.�/ 4, TOTAL SQUARE FOOTAGE: 1 joky ; , <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: ' <br /> (Please round to nearest dollar) SQ�Df�Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Zfres ao ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes / lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes �Jo <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 rev rse) .; Oyes �Vo ODon't know <br /> 7. Is this to correct a violation? Eyes 21,0 <br /> , i _ / <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) f j 740 n I.L� (Continue on Back) -i -♦ <br /> .�'' �'�-076 � / <br />