Laserfiche WebLink
• <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> TM 3 11 LI-P (Z1 rvxtof 1C,. I nc ) Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) `�^,o� Deed Restriction; CSM <br /> P.0. 121:3)(PHoN2 t S��PHONE t bO I �AILADD,�LI„e �w. a�� Variance(# ) <br /> HOME• i► 1 k .+ ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME ll CONTRACTOR NAM <br /> re Sc�1uhni d ie f 3u`\‘uq vt eS tcin\vl�� ❑Site ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS 1 of tic <br /> i 3 IL( &.iiry j 1 S? <br /> \f/n ,State,Zip)e A'cP 0 r (City,State,Zip) ,,1 etbacks <br /> 4jav� ra ' I" l4cJt`4ov k 1 53713 . <br /> PHCKE ` <br /> ,A PHONE ❑Site P approval from <br /> G° 8 -2 57 - 22/34 app. ab township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> r_ Le's0 I t A i 1 bu ` • A or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: EIe n of property <br /> ❑PARCEL qQ-@ 1— rontage drawn to scale. <br /> NUMBER 0101 3 b 2 ' ,✓ <br /> TOWNSHIP: W3)3S SECTION: <br /> To vs r1ct �t d►Son C ,/4. N W /A:514 ❑Drive rmits <br /> (stat , nty,tow <br /> n <br /> As <br /> 1'360 5 Bet �c r �1 Sanitary permits <br /> CSM: LOT UBDIVISION BLOCK/LOT <br /> ••• IC, .vate) qp <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECI DESCRIPTION t' <br /> 3 - jc Se i'cee qG( I I Spr i n ec �ruc-K5,Zoning District <br /> . ❑This project is a new building or structure. ` Permitted Use? <br /> `This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural/Address <br /> C 14 EWER FIEPTIC (ne fi <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ,4___ <br /> 0 'ret /Flo•.- =in/ <br /> f 23- 8 ./.- �j L°f `� Shor- - . attachment) (3rn <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 11'Erosio`nContro permit 01\ <br /> BASEMENT: 1ST FLOOR <br /> © 28 O SQ 4 + TOTAL SQUARE FOOTAGE: + (slopes,distu ce, <br /> L {� filling/access) , C`�< p <br /> 2ND FLOOR: 3RD FLOOR: /� <br /> 0 — © al Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 3(SO,Oas — and available option <br /> (Please round to nearest dollar) <br /> 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [lies g)No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies N.No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ekes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes alo <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? Des ANo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ♦ –► <br /> 545-112(4/08) <br />