Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER DE <br /> G lAd\t 'S Z) loiter oning Status; CUP; <br /> OWNER ADDRESS (Nu ber,Street City,Stat�e``,''�lip) Deed Restriction; CSM <br /> 7757C1 n,lo r. Ko(De6r,v5+&d $35:34 S.40.10 7e4� S/OPFvr �7' Variance(# ) <br /> HOME PHONE - CELL PHONE E-MAIL ADDRES'S <br /> // / . 5 q 4i ' Z e'Iei z c 7R '/•#Cc <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i Ovt-/-t-6114,P r(*on s-/-7u( 0.K ❑Site a ' luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of tic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> JPHONE Le a`�lon' a tl/./9 3 453 9.2-3 ❑Site a royal from <br /> 910 U _ .19(0_670 (Q c appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 ile loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREA P P y <br /> ❑PARCEL l q G frontage drawn to scale. <br /> NUMBER °!l O -d �^�S�a O-/^I C�(J 1 <br /> TOWNSHIP: SECTION: <br /> 4i/ild r 1A: 1/41/<: ❑ Driv-. - :-rmits <br /> ADDRESS: 74 (st- -,c• nty,town) <br /> 1 C,)" US / ❑Sani -# :-rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> /r � S(��/ 013 de-) ' 1I <br /> er <br /> ad � a r oning District <br /> . ❑This project is a new building or structure. -mted Use? <br /> This project is an addition/alteration to an existing building or structure. �, <br /> SANITARY SERVICE: PERMIT U <br /> Gl�.y` 'al Address <br /> FIEWER IA.EPTIC //g/��) �n (rtew/ <br /> HEIGHT IN FEET: NUMBS OF STORIES: (Not including basement)/ ( s ) ❑ Wetland/FloodplaiN <br /> / Sh eland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ErosionC•1 t 01 •-rmit <br /> BASEMENT: 1ST FL0012� O 4, TOTAL SQUARE FOOTAGE: 4, (slope- disturban <br /> �� <br /> Q ♦ filli acre <br /> 2ND FLOOR: 3RD FLOOR: O 0 Co <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ) g and available option <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ $ °1 S /r1 l <br /> 110 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes .'lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CllYes alo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ['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 4R1 o ['Don't know <br /> 7. Is this to correct a violation? ['1'es Al o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />