Laserfiche WebLink
4-C�t/ 5 <br /> ��� SUPPLEnnENT to Web-App # <br /> ZONING PERMIT APPLICATIO www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,, /l ((}} <br /> ✓�JC Ae —x�- A�ic ti -) e �fi<) ❑ Zoning Status; CUP; <br /> bWNERADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3(�I$ eve- G(4vve_ W& - 61 ��s;K) (A") 53'7/ Variance(# ) <br /> HOME PHONE CELL PHON E-MAIL ADDRESS <br /> ' a0-- ( 5'0 Co(9 92O 2O e'I - heK Ij , 4 - i' - ��K ❑ Site Plan dra n Cale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION and includes ensions <br /> AGENT NAME �`` CONTRACTOR NAME <br /> �e/i '-t-a° - a J�,Tc t>6u lOy 4.,c.`�i��5t F-kc_Is', or.-> ❑ Site an ' eluding location <br /> AGEN DRESS CONTRACTOR ADDRESS of wel eptic <br /> 3007(0 00w 5 r/, ° 3oa� thou► s b ea, l< <br /> (City,State,Zip) �� (City,State,Zip) i ❑ Set a S <br /> fLtke_ 4 10(..,.t)J-5 Y14- 5±7°i Piue �(r)rtr n 535/`7 <br /> PHONE PHONE ❑ Site PI., api g al f ,3m <br /> ((OS-- 7(a -Cn,C?/ (.00 . - `7!2 - �cY? applica - to ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Kell -cw gf �.i✓e - awl die//. ec�W s-(- G�r►'�� ° OVi Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURB 9 ITING: f ACREAGE: <br /> ❑ PARCEL /�� 7 frontage drawn to scale. <br /> NUMBER �G��t�IOV i/D� '�`J57."0 ' t,'000 ° r'�r-1 K' <br /> TOWNSHIP: I/ / SECTION: L 47 <br /> ����, O/C Ue"��4d��-- '/4� � '/4'/4: El Driveway permits "i KI� <br /> ADDRESS: (state,count to ) <br /> 2-010 �4 , ❑ TOM Ow"rill p <br /> C <br /> .--, -1-"111% <br /> SM: LOT SUBDIVISION BLOCK/LOT <br /> %?360 /-Of 1 :� b0 • ©fI S Lot r <br /> PROPOSED PROJECT INFORMATION t „ 1 , e <br /> r <br /> PROJECT DESCRIPTION: Q <br /> . ®This project is a new building or structure. M. 7 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: , 8 °-,°=r "� <br /> (SEWER SEPTIC 7,*-1,?Di5 -00/53 y,' `� <br /> HEIGHT IN FEET: n ,,11�� NUMBER OF STORIES: (Not including basement) r <br /> Oc �—c V tX s s a l-.' m <br /> 7� <br /> AREA TO NEAREST SQUARE FOOT: '"' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: l�1ST FLOOR: ( s <br /> 3 ,7 TOTAL SQUARE FOOTAGE: f <br /> C- is <br /> 2ND FLOOR:....../„.70,..F2---71/J ' 3RD FLOOR: fno �i �� <br /> i <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ C J o OOO * a: <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? F,4 Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 4 Yes I__I No <br /> El Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? d Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes I!� 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 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />