Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ' ,, �l <br /> �! e Se e f,�� /v 7 IA Zoning Status; CUP; — 2 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM ■(Dc )QI/2 t� Novo —NZ , /171. �� � Sys Z Variance(# ) 4'� 7 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 771- SZ CP 9 .5t. , . • - ,,, _ . ... . Co t.r11❑ Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes •'11-1 ions <br /> AGENT NAME C TRACTOR NAME _r <br /> �G1r7 l' ' CbN.1rkn� Geu,fL/7� LM ii 7 ,4%:c-- / Site Plan including location <br /> AG NT ADDRES CONTRACTOR DDRESS of well/septic <br /> . 0, j 0. / z- f• a, ,2 010 Z �/ , �y(City,State, ip) (City,State,Zip) ❑ Setbacks <br /> A-r. IT D e to 1 s5 s7 z- plA T--- pi 02e✓8 s-3.s-z- 5G <br /> PHONE PHONE 1=0 Site Plan approval from <br /> (pvt- 7? t_ 77q (Od �a - b 9 -3779 applicable township. �('//4 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> •k.►a t - - L u i t e S-� 4,e u /l Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: 2 CURRE Z'OINING: ACREAGE: , <br /> ❑ NUMBER Q I 0G9 .02-3 - �8 3a-11 /t — S5 frontage drawn to scale. <br /> Lit <br /> TOWNSHIP: y� �/1� SECTION: / (7 <br /> • �� t � � & 6Z 1/4: 5i '/e'/4: J fT • Dnvewa • �- 0, <br /> ADDRESS: (state,county, �. It/ ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT 1=1 Sanita y39 s3/1 <br /> 0 l 0 ' (publi private) <br /> PROPOSED PROJECT INFORMATION <br /> F ' ` ST <br /> PROJECT DESCRIPTION: <br /> S <br /> . ❑This project is a new building or structure. r� t� a W� l V/ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ,h al :=1 <br /> nSEWER SEPTIC new/e ° { <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 WOW. {•.. <br /> ShLNei:A a m ch nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> 104 brosion .. i it <br /> BASEMENT: 1ST FLOOR: <br /> Z 4, D 4, TOTAL SQUARE FOOTAGE: j =,( , , <br /> 2 <br /> 2ND FLOOR: 3RD FLOOR: / <br /> z f'4? Cl Remo Sur <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ ♦ Q available c�pflt� i- <br /> (Please round to nearest dollar) $ -53c:=. #, ',?:#0 ti <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 111No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes M 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 [1 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 ®No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes E No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />