Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> FRft NK KN+PrE R, i'i i ti g N, P��� 617,9 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) `I/ Zoning Status;CUP; / <br /> ?07 N v Q R e p L A �°lc P1 EL b j �3 ` • Deed Restriction; CSM <br /> HOME PHONE CELL -�/� E-MAILADDRESS 1 Variance(# ) <br /> - 0 . 6 / J/y KlV l�A VE/v = i •Al M Site Plan drawn to scale <br /> AGENT INFORMATION �CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 11�� Site Plan including location <br /> AGENT ADDRESS v CONTRACTOR ADDRESS of well/septic d <br /> (City,State,Zip) (City,State,Zip) kl Setbacks u, - <br /> PHONE PHONE IQ Site Plan approval from <br /> applicable township. / , <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale h <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of roe �/` <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: '-� property `-t <br /> — PARCEL /0711 _�3 3'-%(o- f a g,3 frontage drawn to scale. <br /> NUMBER J <br /> TOWNSHIP: SECTI <br /> (,a 4G L'' g p.,o.v� 2 1/4: S hi %ix,: ki Driveway permit <br /> (state,count , own) <br /> ADDRESS: <br /> 190 9 71 ' V( 53 31/ <br /> CSM: LOT SUB ISION BLOCK/LOT d� Sanitary •y��'ts <br /> �_ (public, <br /> PROPOSED PROJECT INFORMATION ST > <br /> PR CT DESCRIPTION: n / 2 x 76, x /6 / /G i <br /> e j <br /> This ro ect is a new buildin or structure. f US (� I '1 8 <br /> ❑ P 1 9 /v A-(icri fer fitted use <br /> [This project is an addition/alte ation tope existing building or structure. c. F/� 'f�Q <br /> SANITARY SERVICE: 18 0 PERMIT NUMBER: r€ <br /> DSEWER 1EPTIC rn�/ I• n ' ' <br /> HEIGHT IN FEET: 1' NUMBER OF STORIES: (Not including basement) <br /> ENE m We . i .�. 3,- n/ <br /> i 5 �0 . . M , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> e_,..,,t, • tz <br /> BASEMENT: 1ST FLOOR: MY f <br /> 2.„ 2 Z j, TOTAL SQUARE FOOTAGE: j, - _ -'� + ti1a i z 2 2_ nth 2ND FLOOR: 3RD FLOOR: r I <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 0 ,A a i 1R�'op}�. <br /> (Please round to nearest dollar) " v ' 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? k es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? NA y,es ❑No ❑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? (se rse ....................... ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? .. ❑Yes No <br /> 4) © , Yo APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* <br /> 545-112(4/08) <br />