Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER ME „ / CUSTOMER TO PROVIDE <br /> /YeLtJ �e f t N7 Z�Td /e4"'�/ 0h arc ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM/'IDS & r C r St Ojack cz t l5,3�� <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> loan 7407 02.147 ii/tc- o ee64e MMPi.1 k-ac ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORP,IATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ti /��5 6,11W1U/7/7 6a/We/1 lei H 140 S-Aeo/l i re/ ❑ Site Plan including location <br /> AGENT ADDRES CONTRACTOR ADDRESS of well/septic <br /> '/o ■&6 'J /0/73 US-/4 <br /> (City State,Zip).__ - (City,State,Zip) El Setbacks <br /> 0, e y/al , a-a/f�s S i, il . . i e kJ, 5-35-&0 oo <br /> ❑/ � ,PHONE PHONE Site Plan approval from <br /> (Pa 573 97S-) 100 7(07 .2586 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> d€6, -1 i-."7/CV rrSJ,. i -/3-i'e /ze/G'4vrs . i • kii.iw• <br /> h❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL ,p 1� .,1�j A,v Ci•,q frontage drawn to scale. <br /> NUMBER ��Dlp '/S3' �%�s L� 7��0 J /t <br /> TOWNSHIP: SECTION: <br /> /1 ,2..e t--/1 i e (035/) /5-4-iv O,Qf1/4: i1/E 1/41/4: Su, ❑ Driveway permits 111 G., <br /> ADDRESS: (state, county,town) <br /> niar ❑ Sanitary permits /lia- <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3� 9 / (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROD T DESCRIPTION: j „ - <br /> (la dci-) ci e d r n 1 <br /> t[ "This project is a new building or structure. ':O <br /> 0 <br /> Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 4kUTa) + t'8S3 <br /> nSEWER nSEPTIC /1 /( ew ng) <br /> HEIGHT IN F :i / i, NUMBER OF STORIES: (Not including basement) � l <br /> ,�Q1..a// / h a. ment) ry <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) u k�sion. <br /> DASEMENT: ST FLOOR: E Tf �It <br /> 3 4, TOTAL SQUARE FOOTAGE: 4, ( +t At y <br /> disturbance, <br /> fal ?access) <br /> 2ND FLOOR: 3RD FLOOR: L <br /> /3s �� <br /> 0 � .���ey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / �ailatlr p s <br /> (Please round to nearest dollar) /i 3 oo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [/No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Ei'%'es ❑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? (see reverse) Eyes r'lo ❑Don't know <br /> 7. Is this to correct a violation? Eyes []rNo <br /> iAPPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ <br /> 545-112(4/08) <br />