Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> 641- .e d 6/v-eN-t. /1--42- e t <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zpning Status; CUP; <br /> Peed�4llC.e P.e bh/f Vet //-- Cz`u r.6 ) A Flat,t-.:- 535go aria Restriction; CSM <br /> ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS // <br /> VC -aj/' 1,3 a? — Ala r1s y C ,141 - n Lf Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION And,includes dimensions <br /> AGENT <br /> A"ill il NAME CONTRACTOR NAM <br /> VD// / (Ccit`- <br /> ` a n Q (c (c ht ) EiSi Plan including location <br /> AGENT ADD ESS CONTR;a(CTORADDRESS o well/septic <br /> /31 i--i.“_ -■ P l a. /31-/ C Lc-k■ pia e-R <br /> (City,State,Zip) (City,State Zip) , ❑Setb Cis <br /> • <br /> PHONE PHONE -" Si 1j . Proval from <br /> o c gub _Sc)6 ❑a p le township. <br /> E-MAIL ADDRESS. / E-MAIL ADDRESS <br /> C"t GO (ie art d- 87`444,4 t�''-�- , &e-yv N FI7or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: ('/9- C RRE T ZON G: ACREAGE: <br /> © frontage evatlOn of property <br /> PARCEL n ,� drawn to scale. <br /> NUMBER 0'7// -/ - 7ex%- 6, <br /> TOWNSHIP: <br /> �d /Vi�le ' c' ` <br /> ADDRESS: SECTION: S G <br /> ---- <br /> p l 1/: S /'/: _ ❑Drivewa rmits <br /> (stat county, own) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sani permits <br /> �,��? ���/� 2 (p lic, private) <br /> PROPOSED PROJECT INFORMATION � •TAFF REVIEW <br /> PROJECT DES,�RI P ION: 112 a�G.:Q� . C'Y`/ c d �OZc _ ■ <br /> V /L-t-� ., .e 0 • Z.ning District <br /> ❑This project is a new building or structure. <br /> ❑ -ermitted se? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: CI Rural dress <br /> EWER EPTIC / /✓J 3 5c (new/e istin <br /> HEIGHT IN FEET: / / "�y�jyiiii�°"4��� NUMBER OF STORIES: (Not including basement) <br /> / ❑ Wetland/ plain/ <br /> y <br /> AREA TO NEAREST SQUARE FOOT: Shor and (attachme <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: r--, ErosionCOn permit <br /> / v --I-- �� ,, TOTAL SQUARE FOOTAGE: + (slopes sturbance, <br /> 2ND FLOOR: 3RD FLOOR: — flllln CCess) <br /> qi,6 ❑ Review Location Surve n <br /> ESTIMATED CONSTRUCTION llar)COST: ♦ ♦ ♦ --► $ 5�7 G and available options. <br /> (Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes pNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 'lo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes IVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes LVo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) s o QDon't know <br /> 7. Is this to correct a violation? Eyes Jlo A4 (aa APPLICATION MUST BE SIGNED <br /> »545- 2(4/08) (Continue on Back) <br />