Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN R NAME �^ <br /> / A/Le S If W40-77 Z 2 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,zip) Deed Restriction;CSM <br /> ?7?0 Cr2.y5'ra c. (.."1,4_ At, Loot , VJ) 53556 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 592-.53 [.'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT E r.W yt CONTRACTOR NAME <br /> A.L r 6-"Ky„�- �,vv,�K et !► ao jevet 14)c. Site Plan including location <br /> AGENT ADDRESS ,I ( CONTRACTOR ADDRESS of well/septic <br /> Ad/ �•�4roc 4 S7 lop( FRoak.f•! s-r.- _ <br /> (City,pate,Zip) (City,State,Zip) ' [Q Setbacks <br /> (4/4.)/4/4etE (Ak 1.3 j f7 WA** .4,8$1i S3-5-17 <br /> / <br /> PHONE PHONE El Site Plan royal from <br /> C oalgs0 - 205 boo/ $4(1- 5/,ss appli a township. <br /> E-MAILADD SS E-MAIL ADDRESS <br /> .-)kr")'P' ,i1 '4�•wcc4 P#Avow*4•Co.- _IA • .&IP �1A 3_,!.,. loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURj TZONING: ACREAGE: 2 Elevation of props <br /> ❑ <br /> NUMBER 09 OS -M3i'q SW-- l I /I,�j frontage drawn scale. <br /> TOWNSHIP: Smnnk• <br /> � G %4: W/4: ❑LE. <br /> Drivewa rmits <br /> 1 (state aunty,town) <br /> ADDRESS: 1 <br /> 7790 C ST'L LAKE RS+ COD) vVt -S.35ST <br /> CSM: LOT SUBDIVISION / BLOCK/LOT El Sanitary • its <br /> 3533 1 _ (publi •rivate) <br /> PROPOSED PROJECT INFORMATION FF REVIEW <br /> PROJECT DESCRIPTION: rr�� 4. <br /> ADD 1 S osoR1 ?pow) t 4-3,Pc r4.-��' * P4eNf ,rgur,N "i� ■ ning District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> Q'fhis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural AA" <br /> EWER EPTIC SAN — (I 'ac (new/ +iliii " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 13 f 2 16-/r ' ❑ Wetland/FI•.,. .,ain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOrela .• offs <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ EroSionContr• • rmit <br /> BASEMENT: 1ST FLOOR: + TOTAL SQUARE FOOTAGE: 1 (slopes, ••_ urbance, <br /> gr FLOG filling/: ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> fel 5` /y9 ❑ Review Location Survey r <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ - i 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? :Yes E}lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ►• es [)lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes gIClo <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 Elko ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [jo <br /> 44. Q APPLICATION MUST BE SIGNED <br /> /� (Continue O Back) ♦ —D■ <br /> 545-112(4/08) (`f) <br /> i' <br />