Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.coom `� SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1J' ikv\lrsi- 1--0.08 L_ LC_ <br /> ❑ Zoning Status UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 1003 C ftk d Vb Deed Re tion; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE '' E-MAIL ADDRESS <br /> -�ob�l" eLL ,,4 5,tAbAu'Sf GiC Q. a maA I CO, 7"J ❑ Site PI n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inc es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Pla I luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s ptic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbbfcks <br /> PHONE PHONE ❑ Site PI .4■• .val from <br /> appli.:• .wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plarcale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of pr erty <br /> ❑ PARCEL 040/o 154_%OI_1 h _ 1 .c a Y frontage d to scale. <br /> NUMBER I"r <br /> TOWNSHIP: SECTION: <br /> m 0 SA+ OSQ._ '/a: '/a'/a: ❑ Drivew p s <br /> ADDRESS: (state, o ,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits hl/ w `/ <br /> (public,private) ?iT t <br /> au 0 V4 <br /> PROPOSED PROJECT INFORMATION , <br /> PROJECT DESCRIPTION: ‘.\0\m, p `` D t '`', i 1 <br /> �. Q,dt`riCZ`r \-�VrUoW`, C3�-t�,C 2, !' ai s.:s <br /> 61 � 1"i��IIStI�? � , <br /> ❑This project is a new building or structure. U P Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: P MIT U R: © Rvi 4dre <br /> F1SEWER ASEPTIC KICL WV-CO 1Q Q(VI(�G L(l2 -,(n t , <br /> HEIGHT IN FEET: e NUMBER OF STORIES: (Not incl ing basement) <br /> 1� kt. t LI Wetland Lei, <br /> hOrelan f,:°.- j i <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: 6„ <br /> • • trol permit <br /> 5� , TOTAL SQUARE FOOTAGE: O - t allee <br /> ,fib, a,. � 4'.' <br /> 2ND FLOOR: 3RD FLOOR: <br /> / `.: r ,- <br /> /'�/ Rem • [��' ['{�',.. <br /> ESTIMATED CONSTRUCTION COST: J� ,\ and' y �, <br /> (Please round to nearest dollar) '♦ '♦ ♦ ♦ ♦ ♦ $ _ C) bV v <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ErNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tdi o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Res •No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EVo <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 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes riSclo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -+ -, -► <br />